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Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.
Introduction/Objective Musculoskeletal stiffness is a common feature in rheumatologic inflammatory diseases but little is known about background joint stiffness in the healthy population. The aim of this survey was to determine the variation in musculoskeletal stiffness with age in a cohort of healthy adults using a patient reported outcome instrument designed to assess stiffness in rheumatoid arthritis. Methods Healthy subjects ≥18 years old were enrolled at two sites. Those with a diagnosis of rheumatological disease were excluded. Each subject completed a 21‐item questionnaire designed to evaluate the severity of musculoskeletal stiffness, its physical impact and psychosocial impact, and to provide an overall stiffness score, expressed as a percentage. Scores were analyzed by age group. Results Two hundred eighty‐two subjects were included with a mean age of 42 years (±17, range 18–85). More than 50% of subjects reported stiffness in each age group but with a low median overall stiffness score of 5.4% (IQR 0, 12.6). Scores were markedly higher in those aged ≥60 years, median 10.0% (IQR 2.6, 21.9), and only in this age group did the majority of subjects report a physical or psychosocial impact of stiffness. Scores in males and females were similar. Conclusion The prevalence of musculoskeletal stiffness in healthy subjects of all ages is not negligible, and the high frequency of stiffness and greater severity in the upper age cohort suggest that the background joint stiffness amongst older subjects should be considered when interpreting stiffness in rheumatologic patients.
Background:Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) have been described after chikungunya virus infection. However, the clinical significance of the symptoms and disease severity in the two conditions has not been directly compared.Objectives:To compare, using identical measures of disease severity and patient outcomes, the impact of disease severity measures and symptoms on outcomes in RA and chronic chikungunya disease.Methods:Forty patients with chronic chikungunya arthralgia two years post-infection and 40 matched patients with RA were enrolled in Roraima, Brazil. Twenty-eight joints were assessed for tenderness and swelling, a pain intensity visual analogue scale, musculoskeletal stiffness questionnaire, modified Health Assessment Questionnaire and the EuroQol EQ5D-5L quality of life assessment were completed. The importance of the various measures of disease severity were analysed using Spearman’s rank correlation and regression analysis.Results:Tender and swollen joint counts, pain and stiffness were all predictive of the HAQ disability index in RA, but only stiffness was significantly associated with disability in chikungunya patients (Table 1). Tender and swollen joint counts, pain and stiffness were predictive for all EQ5D quality of life domains (except anxiety/depression) in RA patients. In contrast, in chikungunya disease, tender joint counts were predictive only of usual daily activities; pain was predictive of impaired mobility, self-care and discomfort, while stiffness was predictive for the mobility and anxiety/depression domains (Figure 1). Swollen joint counts were not associated with any of the patient outcomes in chikungunya disease. Linear regression analysis confirmed (p=0.003) that the effect of swollen joint count on the HAQ disability index depends on the underlying disease.Table 1.Association of disease severity with HAQ disability index in rheumatoid and CHIKV+ arthritisSeverity measureRheumatoid arthritisCHIKV+ arthritisr (p)r (p)Tender joint count0.56 (0.0002)0.24 (0.14)Swollen joint count0.60 (<0.0001)0.002 (0.99)Joint pain (VAS)0.55 (0.0002)0.29 (0.07)Stiffness severity0.57 (0.0001)0.38 (0.02)Figure 1.Association of disease severity with quality of life domains in rheumatoid and CHIKV+ arthritisConclusion:The value of all the disease severity measures tested in RA were confirmed, but tender joint counts may have more limited value in the assessment of chronic chikungunya disease. Joint swelling appears to have little impact for chikungunya patients, while stiffness appears to be an important metric to quantify chikungunya arthritis disease severity.Disclosure of Interests:Hugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Ramão Luciano Nogueira-Hayd: None declared, Maony Rodrigues-Moreno: None declared, Felipe Naveca: None declared, Giulia Calusi: None declared, Richard Amdur: None declared, Karol Suchowiecki: None declared, Gary S. Firestein: None declared, Gary Simon: None declared, Aileen Chang: None declared
BackgroundChronic musculoskeletal (MSK) symptoms such as arthralgia and arthritis develop in up to half of patients after acute chikungunya virus (CHIKV) infection. While MSK complaints are common during the acute infection, chronic post-CHIKV rheumatism represents a more severe outcome and is usually assessed by joint counts, laboratory markers and patient-reported outcomes (PROs). Ultrasound (US) may be a practical tool for predicting and confirming the development of chronic CHIKV.ObjectivesTo evaluate the clinical relevance of MSKUS findings in post-chikungunya rheumatism.Methods80 patients with acute CHIKV infection were enrolled in a prospective cohort study in Jaén, Peru. Clinical exam, US scans using grey-scale and power Doppler (PDUS), and serum inflammatory markers were performed at inclusion and at 3-month follow-up. Patients completed the RAPID3 outcome assessment and a MSK stiffness questionnaire. Joint counts and PDUS scans included 20 pairs of joints. Global synovitis and tenosynovitis scores were calculated following the EULAR-OMERACT recommendations for rheumatoid arthritis (GLOESS).Results59 patients (mean age 35 years, 68% female) were assessed both in the acute infection stage and at 3-month follow-up. 21 patients (35%) met strict criteria for defining chronic CHIKV rheumatism with a mean 4.4 (±2.2) tender joints and RAPID3 scores >6. In the acute infection phase, global PDUS synovitis and tenosynovitis scores correlated moderately with tender joint count and with pain severity, joint stiffness and RAPID3 scores, but were not strongly predictive of patients who went on to develop chronic arthralgia. After 3 months, global PDUS synovitis scores correlated more strongly with tender joint count (r=0.53, p<0.0001), pain severity (r=0.60, p<0.0001), joint stiffness (r=0.53, p<0.0001) and RAPID3 scores (r=0.60, p<0.0001) (Table 1).ConclusionGlobal PDUS synovitis and tenosynovitis scores may be an objective measure of disease severity in patients developing chronic CHIKV rheumatism. Further validation with longer-term follow-up is needed.Table 1.Correlation of synovitis and tenosynovitis PDUS scores with clinical examination and patient-reported outcomes (n=59).PeriodAssessmentVariableSynovitis correlationP-valueTenosynovitis correlationP-valueInclusionClinical examTender joint count0.350.00680.300.0210MSK stiffnessSeverity score0.410.00110.360.0048RAPID3Disability index0.390.00240.330.0119Pain severity0.360.00520.290.0277Patient’s global health0.350.00600.210.1045Overall RAPID3 score0.420.00100.310.0187Month 3Clinical examTender joint count0.53<.00010.52<.0001MSK stiffnessSeverity score0.54<.00010.62<.0001RAPID3Disability index0.480.00010.350.0070Pain severity0.60<.00010.56<.0001Patient’s global health0.56<.00010.59<.0001Overall RAPID3 score0.60<.00010.57<.0001REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsHugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Evotec, Juana del Valle Mendoza Grant/research support from: Sanofi, Evotec, Wilmer Silva Caso Grant/research support from: Sanofi, Evotec, Miguel Aguilar Luis Grant/research support from: Sanofi, Evotec, Andrea NIzzardo Employee of: Evotec, Giulia Calusi Employee of: Evotec, Marie Mandron Employee of: Sanofi, Evotec, Maria-Antonietta D’Agostino Consultant of: Evotec.
Chronic chikungunya disease is associated with a poor quality of life and a variety of symptoms, not restricted to the musculoskeletal system. Patients with chronic chikungunya disease in Guadeloupe were evaluated in order to identify the main factors determining the quality of life. Patients were followed up at a mean of 36 months after chikungunya infection, undergoing detailed clinical examination for musculoskeletal involvement, with assessment of subjective symptoms and the impact on mood, physical activity, and quality of life (SF12). Patients had extensive musculoskeletal involvement shown by tenderness in 9 ± 4 joints and stiffness in 5 ± 4 joints. SF12 physical and mental component scores showed a poor health-related quality of life. Measures of joint pain, stiffness, and inflammation contributed to impaired quality of life scores. In addition, fatigue and interrupted sleep appeared to be important predictors for physical aspects of quality of life. The emergence of anxiodepressive syndromes post-chikungunya infection was associated with both physical and mental component scores of SF12. These data confirm that musculoskeletal symptoms are not the only determinants of quality of life in chronic chikungunya disease. Follow-up of patients should include assessment and management of fatigue, poor sleep quality, and anxiodepressive syndromes.
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