Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 – Treatment

Abstract

Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Chikungunya fever: General and oral healthcare implications

“…Hence, during epidemic situations, in the presence of acute fever, arthralgia/severe arthritis, with or without rash, the possibility of chikungunya fever should be strongly considered. However, other acute febrile diseases should be included in the differential diagnosis, especially in instances of severe and/or atypical clinical disease (Marques et al., ; Marques et al., ,b).…”

“…In epidemic situations, patients in the acute phase may have the diagnosis established based on clinical–epidemiological criteria, without confirmatory serology or associated hematology. For patients at risk (elderly, pregnant, children aged under 2 years or persons with comorbidities), the recommendation is that only the full blood cell count (FBC) should be requested (Marques et al., ; Marques et al., ,b). A more detailed laboratory evaluation may be necessary according to the patient's general conditions, comorbidities, and drug use, especially in elderly patients (Brazilian Medical Council, ; Simon et al., ).…”

“…In the chronic phase, in addition to the routine examinations (FBC, erythrocyte sedimentation rate, and CRP), the need for autoantibody request should be evaluated if the clinical presentation is suggestive of autoimmune disease as well as evaluation of possible comorbidities. Analysis of synovial fluid may be necessary to confirm the inflammatory nature of joint involvement and to aid in differential diagnosis including gout and septic arthritis (Marques et al., ; Marques et al., ,b; Simon et al., ).…”

“…As the clinical–epidemiological criteria used for the diagnosis of chikungunya fever (WHO, ) in epidemic situations show high agreement with the result of the specific serology for CHIKV (Marques et al., ; Marques et al., ,b), it is not recommended to perform this test for the diagnosis of uncomplicated cases. Because of the high attack rate of CHIKV (20% to 50% of the exposed population) (Cunha et al., ), performing specific serology for all cases is practically unfeasible from an economic point of view.…”

“…Patients also require advice concerning posture control, exercises, and graded return to normal motor function. This may include heat, active free, resisted, proprioceptive and aerobic exercises, stretching, manual therapy, and aquatic physiotherapy (Marques et al., ,b).…”