Chikungunya virus (CHIKV) was first isolated in humans in 1952, following an epidemic in Tanzania. The origin of the name means "to bend forward or become contorted," in reference to the posture adopted by patients due to the joint pain that occurs during the infection. Epidemiology data suggest that by the end of 2015, about 1.6 million people had been infected with CHIKV. The acute period of the disease is characterized by high fever, myalgia, joint pain, and severe and disabling polyarthritis, sometimes accompanied by headache, backache, and maculopapular rash, predominantly on the thorax. Around half of the patients will progress to the subacute and chronic phases, that is manifested by persistent polyarthritis/polyarthralgia, accompanied by morning stiffness and fatigue, which could remain for years. Oral features may include gingivitis possibly as a consequence of arthralgia of the hands leading to limited oral health measures as well as burning sensation and oral mucosal ulceration. Treatment in the acute phase includes acetaminophen, and weak opioids (tramadol or codeine) should be used in cases of severe or refractory pain. For patients who have progressed to the subacute stage and who have not had notable benefit from common analgesics or opioids, NSAIDs, or adjunctive pain medications (anticonvulsants or antidepressants) may be of benefit. In patients with moderate-to-severe musculoskeletal pain or in those who cannot be given or tolerate NSIADs or opiates, prednisolone should be prescribed.

BackgroundThe first autochthonous reports of Chikungunya fever (CF) in Brasil was confirmed in 2014, and by December 2016, there were 263.980 probable cases of CF, 55.03% confirmed. According to recommendations of the Ministry of Health (MH) of Brazil, in an established epidemic situation, the diagnosis of CF should be made by appliyng clinical and epidemiological criteria. There is no indication for the serology for Chikungunya virus (CHIKV) in the acute phase, except in atypical cases and complicated clinical situations, which may generate doubts in clinical practice about the correct diagnosis of these patients.ObjectivesThe objective of this study was to evaluate the concordance of the clinical and epidemiological criteria with the serology results for CHIKV in a cohort of patients with CF.MethodsThe multicenter cohort CHIKBRASIL from the Northeast of Brazil has enrolled CF patients with joint manifestations since April 2016, using as inclusion criteria the presence of fever and arthralgia/arthritis in a patient residing or who had visited an endemic or epidemic area within 15 days prior to the onset of symptoms. For the present study, we selected patients in which IgM and/or IgG serology was performed, regardless of the results. For the analysis of agreement with the serology, the most characteristic symptoms of CF were used individually (fever, arthritis/arthralgia or exanthema) and three models of association of symptoms were created: (1) fever and arthralgia; (2) fever and arthritis; (3) fever, arthralgia/arthritis, and exanthema. The sensitivity (SENS), specificity (SPEC), positive predictive value (PPV) and negative predictive value (NPV) of the criteria were also assessed, with the serology result considered the gold standard.ResultsA total of 143 patients were evaluated, 119 (83.2%) of which were female, with a mean age of 53.89 years (± 13.5); 52.4% of the cases were in the subacute phase of the disease (15 days to 3 months) and 42.7% were in the chronic phase (over 3 months). The IgM positivity was observed in 95.1% of cases and IgG in 71.67%. The concordance rate between the IgM serology or combined positive serology (IgM or positive IgG) was over 80% for any of the symptoms/symptoms model analyzed, as well as the SENS and PPV of the symptoms/ symptoms model, which was over 95% in all situations evaluated. The concordance rate for IgG serology ranged from 51.9 to 72.1%. Model 1 presented the highest agreement with the result of positive combined serology.ConclusionsDuring an epidemic situation, the use of clinical and epidemiological criteria shows high agreement with the serology result, regardless of the combination of symptoms presented, with high sensitivity and positive predictive value.Disclosure of InterestNone declared

BackgroundThe mechanisms of nonarticular pain associated with Chikungunya virus (CHIKV) infection are still poorly understood. Many patients that progress to Subacute/Chronic phases have neuropathic pain (NP) besides the articular symptoms. The NP is associated with a less favorable outcome, with greater impact on quality of life and lower efficacy of treatment. The NP can reflect a dysfunction of the nervous system, rather than a neurological lesion induced by CHIKV, but the pathophysiology of the neural disfunction is not completely understood. There are no studies evaluating the electroneurographic findings in patients with CHIKV infection and neuropathic symptoms.ObjectivesTo evaluate the results of electroneurography (ENoG) of patients with Chikungunya Fever (CF) and neuropathic symptoms.MethodsPatients with diagnosis of CF (clinical and epidemiological) and symptoms of paresthesias underwent ENMG of upper and lower limbs. The electrodiagnostic evaluation consisted of nerve conduction study of median, ulnar, tibial, fibular, sural and plantar nerves. Clinical and epidemiological data were also recorded.ResultsThe sample was composed by 18 patients (82.3% females) with mean age of 56 (±9.9) years. The mean duration of symptoms of CF at the time of the ENoG was 23.8 (±10.8) weeks and the average of tender and swollen joints (including ankle and foot) was 29.6 (±21.5) and 9 (±9.9), respectively. The mean score of visual analogic scale (VAS) for pain was 4.4 (±2.4) and for fatigue was 5.9 (±2.9), considering values between 0 and 10. No patient presented axial pain and the number of painful joints was higher in upper (19.4±13.9) compared to lower limbs (10.2±8.4). Only 3 patients reported unspecific paresthesias prior to the onset of arbovirosis and worsening after CF. However, these 3 patients had normal ENoG. Six patients had diabetes. Mononeuropathy was the most frequent result occurring in 12 subjects (67%). Bilateral mononeuropathy of median nerve (at carpal tunnel) was found in 11 patients and one subject had median neuropathy just on the left hand. Other mononeuropathies were also present: bilateral tibial nerve in 4, bilateral plantar nerve in 2 and bilateral fibular nerve in 1 patient. Distal axonal polyneuropathy was present in 8 cases (6 sensory and 2 sensorimotor); 5 of these were diabetic. The ENoG was normal in 4 cases. Ten patients were in use of prednisone (mean dose 11.4mg/d) and just 6 were using antineurophatic agents.ConclusionsOur preliminary results indicate that the ENoG is altered in most patients with chronic articular manifestations of CF and associated paresthesias. Mononeuropathy is the most commom finding, even in the chronic phase of the disease when the nonarticular edema is not common. Further clinical studies with a larger number of patients and follow-up tests will be needed to confirm our data.References Andrade DC, Jean S, Clavelou P et al. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness. BMC Infectious Diseases 2010 10:31. Disclosure ...

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band-like focal sclerosis, representing condensation of trabeculae, mostly without prominent periosteal reaction. Symmetrical involvement, as in our patient, is not unusual. 1 The findings in our patient with extensive periarticular bone loss (due to rheumatoid knee involvement), demarcated by a contrasting horizontal band-like sclerosis, caused by bilateral stress fractures of the proximal tibial epiphyses, is, however, a rather exceptional radiographic presentation.

BackgroundAn epidemic of Chikungunya Fever (CF) spread throughout South America in 2014. The acute manifestation of CF typically consists of febrile arthritis. The burden of the chronic articular manifestations remains a public health issue affecting activities of daily life. There is a very important impact on quality of life in patients affected by CF, even at chronic phase. The long-term functional status may also be affected by CF.ObjectivesTo evaluate longitudinally the disability, Health Related Quality of Life (HRQOL) and functional status of patients with CF and analyze the clinical and epidemiological factors associated with different outcomes.MethodsPatients with clinical and demographic diagnosis of CF and persistent articular symptoms were evaluated in a cohort study between May 2016 and December 2016. HRQOL was rated by Short-Form 12 (SF-12) and the functional status was checked through Health Assessment Questionnaire (HAQ) and the Global Functional Status (GFS). Data were divided per weeks after disease onset and were analysed (Spearmans's correlation coefficient and Mann-Whitney test).ResultsSixty-five patients (58 females), mean age of 51.3 (±13.3) were assessed. As expected, a significant correlation between pain related scores and Physical Health Composite Scale Score (PCS), HAQ and GFS was found (p<0.05)). Edema and morning stiffness correlated with PCS, HAQ and GFS status from 4 to 20 weeks after disease onset (p<0.05). There was improvement in scores of all instruments used from 4–8 weeks of disease to 12–16 weeks of disease (table 1). The worst indices of PCS, Mental Health Composite Scale Score (MCS) and GFS were scored in the first month, mean scores of 30.07±5.77, 38.13±8.54 and 3.15±1.07 respectively. Higher HAQ values were demonstrated between 4 and 8 weeks after disease onset (mean score 1.87±0.82).HRQOL and Functional Status in patients with CF4–8 weeks of disease12–16 weeks of diseaseP value (mean score)(mean score) PCS30.12±8.2135.86±11.110.0487MCS40.95±12.2347.02±12.090.0326HAQ1.87±0.821.36±0.860.0228Global Functional Status3.03±0.982.53±0.950.0438ConclusionsWe demonstrated the impact of CF on HRQOL and Functional Status of patients. The SF-12 Health Survey, HAQ and GFS are influenced mostly by patients pain and worsening of this status are more prominent in the first 8 weeks of disease. Further clinical studies of the impact of CF on quality of life and functional studies are neededReferences Soumahoro MK, Gérardin P, Boëlle PY et al. Impact of Chikungunya virus infection on health status and quality of life: a retrospective cohort study. PLoS One. 2009 Nov 11;4(11):e7800.Rahim AA, Thekkekara RJ, Bina T et al. Disability with Persistent Pain Following an Epidemic of Chikungunya in Rural South India. J Rheumatol. 2016 Feb;43(2):440–4.Couturier E, Guillemin F, Mura M et al. Impaired quality of life after chikungunya virus infection: a 2-year follow-up study. Rheumatology (Oxford). 2012 Jul;51(7):1315–22. Disclosure of InterestNone declared

BackgroundChikungunya fever (CF) is an infectious disease caused by a RNA virus and its transmission occurs by the inoculation of the virus by the female bite of Aedes aegypti mosquito. In Brazil, where the vetor is endemic, the virus rapidly disseminated and there was an epidemic, specially in the Northeast region of the country with 263.980 notified cases in 2016. It is known that CF may have a chronic course with articular symptons, however there is not consistent data in the medical literature on CF evolution in patients with prior rheumatic diseases.ObjectivesTo assess whether there is any difference in the characteristics of articular manifestations of CF in patients with prior inflammatory rheumatic diseases (IRD), non-inflammatory rheumatic diseases (NIRD) and controls (patients with no diagnosed prior rheumatic diseases).MethodsCross-sectional study using a database from CHIKBRASIL cohort. Patients enrolled had clinical and epidemiological characteristics of CF and were classified in three groups: IRD (rheumatoid arthritis, axial spondyloarthritis and systemic lupus erythematosus), NIRD (fibromyalgia and osteoarthritis) and controls (no prior rheumatic diseases).ResultsA total of 150 patients were enrolled. There were 55 patients with IRD, 40 patients with NIRD and 55 controls, paired by age and sex. There were no differences in acute phase symptoms in the groups. There a was more frequent occurrence of arthritis in patients with IRD compared to NIRD (p=0.001) and to controls (p=0.002). In 89.1% of the patients with IRD there was an underlying disease exacerbation and 74% described an expressive worsening of symptoms compared to the period prior to infection. Patients with IRD had an increase in the current dose of corticosteroids (median 10mg, IQR 10–20) compared to previous dose used (median 6mg, IQR 5–10) after the onset of CF (p=0.0007). Importantly, there was more methotrexate prescription (23.5%) in IRD group, compared to NIRD group (0, p-0.001) and to controls (3.7%, p=0.003).ConclusionsPatients with IRD and CF presented significantly more arthritis compared to NIRD or to controls. CF seems to induce underlying rheumatologic disease exacerbation in patients with inflammatory disease and a more aggressive therapeutic approach might be necessary in this group of patients.Disclosure of InterestNone declared

BackgroundChikungunya Fever (CF) is an arbovirosis with a high attack rate, affecting large proportion of the population in its outbreaks (85%>90% of infected are symptomatic). In general, it is recommended to carry out laboratory tests when patients reach subacute phase or show signs of severity at the beginning of the disease. There are few studies showing which laboratory results are relevant and their clinical applicability.ObjectivesTo recognize the most frequent findings of laboratory tests in a cohort of patients with CF and chronic joint symptoms and to correlate laboratory results with clinical data.MethodsPatients with diagnosis of CF (clinical and epidemiological criteria) were followed in a cohort study. Clinical data and laboratory tests were collected in a regular schedule in the first months of the disease.ResultsA total of 54 patients were enrolled during 10 months, persistent changes in some patients were recorded (table).Table 1.Persistent laboratory findings in patients with Chikungunya Fever in subacute/chronic phases> 50%Decreased vitamin D (53.8%)40%>50%Increased CRP (43.3%)30%>40%Decreased: HDL cholesterol (36.5%), eosinophil (37.3%),20%>30%Increased: glucose (28.3%), GGT (27.4%), γ globulin (27.4%), glycated hemoglobin (26.4%), calcium (25.4%), alkaline phosphatase (24.5%), β globulin (23.5%), cholesterol (23.0%) Decreased: total bilirubin (20.0%)10%>20%Increased: triglycerides (17.6%), LDH (17.3%), ferritin (13.7%), ALT (13.2%), direct bilirubin (12.0%), α2 globulin (11.7%) Monocytosis (11.1%), Limphocytosis (10.0%)5%>10%Hyperchloremia (8.0%) Increased: neutrophils (7.54%), LDL (5.88%), folic acid (5.88%), uric acid (5.76%), platelets (7.54%) Decreased: CPK (7.54%), albumin (5.88%), neutrophils (9.43%) Hyponatremia (5.88%),CRP = C reactive protein, GGT = gamma glutamyl transferase, LDH = lactate dehydrogenase, ALT = alanine aminotransferase, CPK = creatine phosphokinase.In the subacute phase, the ESR (erythrocyte sedimentation rate) correlated with number of swollen joints (r=0.45, p=0.03), VAS (visual analogue scale) of pain (r=0.72, p=0.0002), VAS patient's general health (r=0.50 p=0.02), VAS by physician (r=0.45, p=0.03) and with HAQ (r=0.51, p=0.01). In subacute phase the VAS of morning stiffness correlated with CRP (r=0.46, p=0.02). In chronic phase, CRP correlated with VAS of pain (r=0.47, p=0.02) and there was a reversal in the correlations between ESR and VAS of general health of the patient (r=-0.54, p=0.03), VAS of physician (r=-0.52, p=0.02), swollen joints (r=-0.46 p=0.03) and HAQ (r=-0.56, p=0.01). ESR and SF-12 (mental component) were correlated (r=0.61, p=0.01).ConclusionsLevels of ESR correlated with measures of pain and worsening of functional capacity in subacute phase. In chronic phase, there was reversal of this correlation, indicating that ESR does not reflect clinical worsening of patients at this stage. Further clinical studies are needed to better analize other alterations.References Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne di...