Identification of initial severity determinants to predict arthritis after chikungunya infection in a cohort of French gendarmes

Abstract

BackgroundThe objective was to identify severity characteristics of initial chikungunya infection (CHIKV) stages associated with post-CHIKV arthritis and arthralgia.MethodsFrench gendarmes exposed to the 2005–2006 CHIKV epidemic in Reunion Island who completed the 2006 (self-reporting acute and early chronic [median: 6 months] symptoms) and 2008 (Endpoint [median: 30 months]: self-perceived recovery and rheumatic disorders (RDs)) surveys were included. Multinomial logistic regression and multiple correspondence analysis (MCA) were used. Arthralgia was defined by joint pain and/or stiffness and arthritis by joint swelling in addition to pain and/or stiffness.ResultsIn 2008, 124 (31.3%)/403 participants (101 CHIKV+/302 CHIKV-) reported arthralgia and 57 (14.1%) arthritis. The multivariate model kept CHIKV infection, comorbidity and acute stage depressed mood as independent prognostic factors for both arthralgia and arthritis, but found early chronic stage RD as the main determinant of the same RD two years later.The MCA performed with the 85 CHIKV + patients who answered the question on self-perceived recovery enabled the calculation of severity scores based on initial symptoms that were strongly associated with persistent arthritis and, to a lesser extent, to arthralgia in bivariate analyses. The MCA graph clearly distinguished arthritis as the only RD associated with early severity indicators represented by sick leave, joint swelling and depressed mood during the acute stage, and early chronification of arthritis and depressed mood.ConclusionInitial CHIKV severity predicted recovery, with higher severity associated with arthritis and lower severity with arthralgia. More interestingly, specific markers of post-CHIKV arthritis, which can easily be used by clinicians for case management, were identified.

Pharmacologic management of pain in patients with Chikungunya: a guideline

“…In an outbreak in Italy, Moro et al reported that IgM was detected in 52% (131/249) of patients within 5 months of the contracting disease and in 13.2% (30/227) with 12 months of disease evolution (17) . Other risk factors associated with progression to a chronic form include age >35 years, marked joint impairment in the acute phase, and pre-existing prior joint disease (4) (9) (18) . Some patients have polymorphisms of the human leukocyte antigens (HLA) that are associated with rheumatic diseases, such as HLA-27.…”

Chikungunya

“…The presence of immunoglobulin M (IgM) antibodies detected months after the acute infection suggests persistence of the virus or its antigens; this may perpetuate the inflammatory process in the joints. 41,44 In an outbreak in Italy, Moro et al reported that IgM was detected in 52% (131/249) of patients within 5 months of the contracting disease and in 13. 2% (30/227) with 12 months of disease evolution 42 .…”

“…A classical switch from CD+ 8 cell to CD4+ T-cell response and the production of anti-inflammatory proteins IL-1RA and IL-they do not directly depend on an inflammatory processes, but involve specific changes in central and peripheral nociceptive processes. 44 Therefore, it seems that the mechanisms are multifactorial and may different between patients. A clear understanding of the pathophysiologic mechanisms in patients with Chikungunya will have a direct bearing on the choice of ideal therapeutic agent to relieve the pain.…”

“…Other risk factors associated with progression to a chronic form include age >35 years, marked joint impairment in the acute phase, and pre-existing prior joint disease. 42,43,44 Some patients have polymorphisms of the human leukocyte antigens (HLA) that are associated with rheumatic diseases, such as HLA-27. These HLA polymorphisms may be involved in the pathogenesis of the disease.…”

Sat0456 sero-Reactivity to Galactose-Alpha-1,3-Galactose and Clinical Presentations of Patients Seen in a Rheumatology Outpatient Practice

“…Guidelines advocate specialists sharing responsibility with GPs. 57% of rheumatologists considered GPs responsible (2). Perhaps, we should take a more active approach.…”