Inflammatory biomarkers, disease activity index, and self-reported disability may be predictors of chronic arthritis after chikungunya infection: brief report

Abstract

The chikungunya virus (ChikV) is a reemerging mosquito-borne pathogen that causes disabling chronic arthritis. The relationship between clinical evolution and inflammatory biomarkers in patients with ChikV-induced arthritis has not been fully described. We performed a prospective case series to evaluate the association among joint involvement, self-reported disability, and inflammatory biomarkers. Patients with ChikV infection were followed for 1 year. Joint involvement and self-reported disability were evaluated with disease activity index 28 (DAS-28) and World Health Organization Disablement Assessment Schedule II (WHODAS-II). Interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were used as biomarkers. Ten patients with mean age 48 ±15.04 years were included. Symptoms at diagnosis were fever, arthralgias, myalgias, rash, arthritis, nausea, vomiting, and back pain. Polyarticular involvement was present in seven cases. At diagnosis, measures were as follows: DAS-28, 5.08±1.11; WHODAS-II score, 72.3±10.3 %; CRP, 5.09±7.23 mg/dL; ESR, 33.5±17.5 mm/h; RF, 64±21.7 IU/mL; and IL-6, 17.6±10.3 pg/mL. Six patients developed subacute and chronic symptoms. During follow-up, DAS-28 index, WHODAS-II score, ESR, and IL-6 were statistically different in patients with subacute and chronic symptoms compared to those who resolved in the acute phase (p < 0.05). DAS-28 index, WHODAS-II score, and IL-6 were related to chronicity of articular symptoms and could be used as predictors of ChikV-induced arthritis.

Review: Chikungunya Arthritis: Implications of Acute and Chronic Inflammation Mechanisms on Disease Management

“…IL‐6 is specifically expressed in the affected joints and could stimulate the release of RANKL while inhibiting the action of its decoy receptor osteoprotegerin released by osteoblasts, resulting in osteoclastogenesis and severe bone loss, as has been shown in mice . Indeed, while bone loss is not a defining feature in patients with chronic chikungunya arthritis, recent studies appear to implicate IL‐6 as a possible biomarker of chronic chikungunya virus .…”

The Identification of Risk Factors for Chronic Chikungunya Arthralgia in Grenada, West Indies: A Cross-Sectional Cohort Study

“…The severity of acute CHIKV disease has previously been reported to be predictive of recovery and long-term arthritis and arthralgia symptoms [ 18 , 21 , 34 , 42 ]. Similarly in our study, several acute symptoms—including dizziness, retro-orbital pain, photosensitivity, stiff neck, sore throat, and altered mental state, which are suggestive of more severe illness—were found to be associated with increased chronic disease risk.…”

Clinical Features and Management of Chronic Chikungunya Arthritis

“…A prospective Mexican cohort study showed that greater severity of acute infection predicted development of chronic arthritis, as measured by the disease activity index 28 (DAS28), World Health Organization Disablement Assessment Schedule II (WHODAS-II), and serum IL-6 level [25]. Other risk factors for chronic disease include patient age >45 years and high viral load (>10 9 per ml) during acute infection [26].…”