Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging

Abstract

This longitudinal follow-up study of 203 patients with serologically confirmed chikungunya (CHIK) virus infection describes the clinical features of CHIK fever during the first and tenth months of illness. During the acute stage CHIK fever presents with a wide array of symptoms. The foremost chronic symptoms at the end of a month were rheumatism (75%) and fatigue (30%). During the tenth month of follow-up the symptoms/signs observed were joint pain/swelling (46%), fatigue (13%) and neuritis (6%). The cure rate at the end of 9 months was 51%. Among the patients who had joint pain, 36% (34/94) met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis. A subpopulation of the patients with joint pain (20/94) was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody, and the joints were imaged by X-ray and magnetic resonance imaging (MRI). All tested negative for RF and one tested positive for anti-CCP. A radiolucent lesion in the X-ray was seen in the bones of five patients. The MRI findings were joint effusion, bony erosion, marrow oedema, synovial thickening, tendinitis and tenosynovitis. The study proves with relative certainty that CHIK arthritis is chronic inflammatory erosive arthritis, which has implications for management of the infection.

The hidden burden of Chikungunya in central Mexico: results of a small-scale serosurvey

“…The local climate is mostly warm and semi-arid, with a mean yearly temperature of 24°C (range, 18º C to 28º C) and precipitation of 930 cubic millimeters (range, 800 to 1 200 mm 3 ). 16,17 The study area included three adjacent census tracts (basic geostatistical areas or AGEB, by its Spanish initials), 0041, 0198 and 0200, that conform a conglomerate of irregular shape between the limits of latitude 18° 36' 57.3" North to 18° 61' 59.29" South; and longitude 99° 19' 10.8" East to 99°31' 96.62" West.…”

Chikungunya: Molecular Aspects, Clinical Outcomes and Pathogenesis

“…The musculoskeletal disorders include arthralgia, inflammatory arthritis, polyarthralgia, tenosynovitis, enthesitis, and exacerbation of existing rheumatic disease 29,[41][42][43][44][45][46] . Other less common symptoms include neuropathy, cerebral disorder, neurosensory deficiency, burning mouth syndrome, paresthesia, cubital tunnel syndrome, gastrointestinal disorders, exanthema, pruritus, bursitis, and synovitis 28,36,44,[47][48][49] .…”

“…Other less common symptoms include neuropathy, cerebral disorder, neurosensory deficiency, burning mouth syndrome, paresthesia, cubital tunnel syndrome, gastrointestinal disorders, exanthema, pruritus, bursitis, and synovitis 28,36,44,[47][48][49] .…”

“…Infection with CHIKV has been associated with destructive rheumatoid arthritis, which is similar to rheumatoid arthritis and induces a similar inflammatory response, although the laboratory tests are negative for the rheumatoid factor and the antibodies for cyclic citrullinated peptides (CCP) 26,44,50 . Radiographic studies of some of these individuals show bone erosion, swollen joints and synovitis 44,51 .…”

Chikungunya and Its Interaction With the Host Cell

“…Several studies have tried to identify the factors associated with chronic Chikungunya disease in groups of patients in Singapore [83], La Réunion [84], Dakshina Kannada (India) [85,86], and Emilia Romagna (Italy) [87]. Regulatory mechanisms silencing the vigorous (even localized) inflammatory response seem to be required to prevent the establishment of chronic disease weeks or even months after viral clearance from the blood.…”