Pan-American League of Associations for Rheumatology–Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America

Monge, Pablo; Vega, José M.; Sapag, Ana; Moreno, I.Y.; Montúfar, Rubén; Khoury, Vianna; Camilo, Pablo R.; Rivera, R.E.; Rueda, Juan C.; Jaramillo-Arroyave, Daniel; Londoño, John; Ruiz, Mercedes Pérez; Fernández, Félix Rodríguez; Quintero, Maritza; Fuentes-Silva, Yurilís; Aguilar, José; Vallejo-Flores, Carlos; Caballero-Uribe, Carlo V.; Sandoval, Hugo; Pineda, Carlos

doi:10.1097/rhu.0000000000000868

Cited by 12 publications

(64 citation statements)

References 44 publications

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“…Alternatively, instead of IFNγ expression by T H 1 cells, TNF expression by CD4 cells might have an important function in promoting chikungunya arthropathy 135 . TNF-expressing CD4 cells have a potential pathogenic function in psoriatic arthritis 143 and are targeted by methotrexate in RA 144,145 ; notably, methotrexate has shown some benefit in treating chikungunya 146,147 .…”

Section: Cd4 T Cells Chikv-specific Cd4 T Cells Have Beenmentioning

confidence: 99%

“…A number of consensus guidelines 30,146,171 , reviews 2,35,113,[172][173][174] and perspectives 37,175 for the treatment and management of chikungunya are available. In summary, acetaminophen (paracetamol) is recommended for the initial treatment of fever and pain.…”

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

“…However, NSAIDs are contraindicated in several comorbidities, including uncontrolled hypertension, kidney disease and inflammatory bowel disease, and NSAIDs should be discontinued in pregnant patients 6-8 weeks before birth. Low-dose corticosteroids (with or without NSAIDs) seem to be effective in NSAID-refractory pat ients 35,113,146,171,175 , although the potential adverse effects of these drugs should be considered in risk-benefit assessments 31,176 . For patients with chronic chikungunya who are refractory to the aforementioned treatments, DMARDs have shown some efficacy 113,172 , and sulfasalazine and methotrexate have been suggested as first-line options 146,147 .…”

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

“…Low-dose corticosteroids (with or without NSAIDs) seem to be effective in NSAID-refractory pat ients 35,113,146,171,175 , although the potential adverse effects of these drugs should be considered in risk-benefit assessments 31,176 . For patients with chronic chikungunya who are refractory to the aforementioned treatments, DMARDs have shown some efficacy 113,172 , and sulfasalazine and methotrexate have been suggested as first-line options 146,147 . However, chikungunya arthropathy is usually not overtly erosive 16,47 , and so DMARDs might seem hard to justify 177 unless an underlying destructive autoimmune disease is present.…”

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

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Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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Chikungunya virus (CHIKV) is a member of a group of globally distributed, mosquito-transmitted arthritogenic alphaviruses that cause sporadic outbreaks of primarily rheumatic disease every 2-50 years 1-4. The largest epidemic of CHIKV disease (hereafter simply referred to as chikungunya) ever recorded began on Lamu Island, Kenya, in 2004 (Fig. 1). The epidemic expanded across four continents, with cases still being reported in 2019 (Fig. 1; Supplementary Table 1). Three major genotypes of CHIKV are now recognized-the Asian, the West African and the Asian and East-Central South African (ECSA) genotypes 5-but a new lineage, the Indian Ocean Lineage (IOL), also emerged from the ECSA genotype during the 2004-2019 epidemic 6. The epidemic reached >100 countries (Supplementary Table 1), caused >10 million cases (Supplementary Table 2), and might arguably be called a pandemic. An estimated 1.3 billion people are at risk of chikungunya 7. Climate change modelling suggests that many more areas of the world (including parts of China, sub-Saharan Africa, South America and the United States) might become able to accommodate transmission of CHIKV in the future 8,9. Chikungunya was previously often viewed as (and for many patients remains) a relatively benign and selflimiting rheumatic disease. However, a considerably more complex spectrum of less common atypical and severe manifestations is now recognized in subgroups of patients, with chikungunya often complicated by comorbidities and co-infections. Hospitalization rates for chikun gunya range from 0.6% to 13% 10-14 and estimates of chikungunya-related mortality range from 0.024% to 0.7% 10,12,15-17. In addition, many patients develop protracted rheumatic disease lasting many months, occasionally years, with a number of sequelae now also recognized 18-22. Estimates for the total economic costs (direct and indirect) of chikungunya have ranged from a median of US$67 for adults and $258 for children in Columbia 23 , to a mean of $150 per outpatient and $3,300 per inpatient in 2006 in Réunion Island 11. In a large study of a chikungunya outbreak in Bangladesh in 2017, >10 days of productivity were lost in ~30% of patients with chikung unya because of severe arthropathy 24. Such costs might be viewed as relatively modest by Western standards; however, the occasionally high attack rate of chikungunya, with up to 30-75% of a given population affected by chikungunya disease at any one time 1,25 , can result in a substantial economic burden, especially in resource-poor communities that are often affected by the disease 26. Considerable research in patients and animal models has now provided extensive insights into the complex Pandemic An epidemic of disease that has spread across a large region; for instance, multiple continents, or even worldwide. Attack rate The total number of new cases of a disease divided by the total population (that is, the percentage of a defined population that is affected by a disease).

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Section: Cd4 T Cells Chikv-specific Cd4 T Cells Have Beenmentioning

confidence: 99%

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

Section: Treatments and Vaccines Anti-inflammatory Therapymentioning

confidence: 99%

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Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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“…[141516] Swollen joints and tender crippling arthritis are evident, involving more than 10 joint groups and usually radiological findings are normal. [2223] Pregnant patients if affected may abort during the first trimester and transmission to child may happen during term. [242526] Cardinal features such as encephalitis, neuropathy myoclonic seizures, acute flaccid paralysis multiorgan involvement, and ocular involvement were reported.…”

Section: Chikungunyamentioning

confidence: 99%

Adult immunization – Need of the hour

Jairaj

Shirisha

Abdul

et al. 2018

J Int Soc Prevent Communit Dent

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Immunization is the process of making individuals immune. Childhood immunization is a common process for various aliments, but adult immunization in the Indian scenario is obscure. Officially, India has been declared polio-free, which is an achievement despite cultural, political, economic, geographic, and so many other factors. The changing demographics of adult, geriatric population and growing cost of health-care maintenance are a concern in developing countries like India. Thus, promoting healthy lifestyle needs prevention, early detection, and management of various diseases and disorders. Certainly, prevention in adults is yet to be tapped completely, so that goal of 100% prevention can be achieved. Various fraternities of medical association have come up with guidelines for adult immunization schedules in India. The present paper reviews infectious diseases such as anthrax, chikungunya, cholera, dengue, influenza, and malaria in this section of the review. We humbly request all health-care professionals and educators to educate the mass for adult immunization. So that, cost involved for treatment and workforce for the management of diseases can be better utilized in some other needed areas.

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