Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination

Abstract

Objective: Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. Methods: Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinicianexperienced in joint DUSwho also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. Results: In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. Conclusion: Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations.

Role of Arbovirus Infection in Arthritogenic Pain Manifestation—A Systematic Review

“…No erosion was observed. Subcutaneous inflammatory infiltration (cellulitis) was observed in only a minor proportion of the participants [22]. In summary, RT-PCR was used in all studies that mentioned a diagnostic method, even in association with other alternative methodologies.…”

“…Vijayalakshmi et al, 2017, showed that molecular mimicry between viral protein E1 and host proteins contributes to the development of arthritic manifestations by CHIKV through increased immune and inflammatory responses [21]. Another important study identified conserved regions of the alphavirus structural polyprotein that are homologous to human proteins involved in rheumatoid arthritis, which can be recognized by B cells and the MHC class II receptor [22].…”

Treatment of chikungunya musculoskeletal disorders: a systematic review

“…In the lack of high-strength evidence against CHIKF musculoskeletal manifestations, most recommendations have adopted therapies used for more common inflammatory arthropathies, with the use of chloroquine derivatives and disease modifying anti-rheumatic drugs (DMARDs). Such variety demonstrates the important gap on evidence on how to better manage CHIKV [12,13,14,15,16,17,18,19,20]. Biologic DMARD (bDMARD) have also been used to treat refractory cases of chronic arthritis [12,17,19].…”

“…Such variety demonstrates the important gap on evidence on how to better manage CHIKV [12,13,14,15,16,17,18,19,20]. Biologic DMARD (bDMARD) have also been used to treat refractory cases of chronic arthritis [12,17,19]. For patients with severe neuropathic pain, amitriptyline hydrochloride, gabapentin or pregabalin may be combined with the analgesics being used.…”