Natural history of Ross River virus‐induced epidemic polyarthritis

Abstract

Objective: To describe the natural history, treatment and cost of Ross River virus‐induced epidemic polyarthritis (RRV disease). Design: Questionnaire‐based longitudinal prospective study. Participants and setting: Patients in the greater Brisbane area, Queensland, diagnosed with RRV disease by their general practitioners based on clinical symptoms and paired serological tests between November 1997 and April 1999. Main outcome measures: Scores on two validated quality‐of‐life questionnaires (Clinical Health Assessment Questionnaire and Medical Outcomes Study Short Form 36) were obtained soon after diagnosis and one, two, three, six and 12 months thereafter. Scores were compared between patients diagnosed with RRV disease alone and those with RRV disease plus other conditions. Results: 67 patients were enrolled. Most patients with RRV disease alone had severe acute symptoms, but followed a consistent path to recovery within three to six months. Other conditions, often chronic rheumatic diseases or depression, were identified in half the cohort; their quality‐of‐life scores suggested stable chronic illness between six and 12 months after diagnosis. Non‐steroidal anti‐inflammatory drugs (NSAIDs) were taken by 58% of patients (average use, 7.6 weeks; range, 2–22 weeks). Time off work averaged 1.9 days, and direct cost to the community was estimated as $A1018 per patient. Conclusions: Symptom duration and frequency of long‐term symptoms may have been overestimated by previous studies of RRV disease. Disease persisting six to 12 months after RRV diagnosis was largely attributable to other conditions, highlighting the need to seek other diagnoses in RRV patients with persistent symptoms.

Mannose Binding Lectin Is Required for Alphavirus-Induced Arthritis/Myositis

“…Current therapy involves administration of non-steroidal anti-inflammatory drugs, and given the role that complement plays in mediating severe RRV-induced disease, treatment with complement inhibitors may provide an attractive alternative to nonspecific anti-inflammatory drugs. However, prolonged inhibition of the complement system can leave patients susceptible to other infectious diseases, especially as treatment of disease symptoms may require several months for some individuals [38]. Our results suggest that a more focused approach targeting MBL may prove effective in limiting RRV-induced arthralgia/myalgia, while limiting the general immune suppression associated with complement inhibition.…”

Molecular Mechanisms Involved in the Pathogenesis of Alphavirus-Induced Arthritis

“…Drugs used to control inflammation in patients with RA have been used as supportive therapy to joint symptoms in patients infected with RRV and CHIKV, but the results were limited and variable [28, 69, 119]. Mouse models for RRV and CHIKV infections have been useful to test drugs that control host inflammatory response, such as bindarit, an inhibitor of MCP-1 receptor [91, 92].…”

“…Fever can be absent in some cases, mainly in SINV, RRV, and BFV infections [21, 26, 27]. Arthritis is the most prevalent among the symptoms, with the recovery from pain and swelling occurring after some days of infection, although several reports describe the persistence of joint manifestations for months or even years [2, 19, 22, 28–31]. Joint pain and inflammation mainly affect symmetrically the small joints (such as those from fingers, wrists, and tarsus), but eventually occur in the large joints (such as those from knees and shoulders) and may also involve several joints simultaneously (polyarthralgy/polyarthritis) [13, 21, 29, 30].…”

“…Chronic arthralgia and arthritis due to alphavirus infection cause clinical manifestations ranging from only a restriction of movements with persistence of swelling and pain to a severe and incapacitating disease [14, 28, 29, 43, 44]. Several studies in which patients infected with CHIKV were accompanied for long periods after La Réunion epidemics consistently demonstrated the chronic and severe manifestation of disease [14, 31, 43, 45].…”

Impact of Chikungunya Virus Infection on Health Status and Quality of Life: A Retrospective Cohort Study

“…Concurrently, following the reports of long-term clinical manifestations of Ross River virus disease, two prospective longitudinal studies were conducted, one of them based on clinical review [24], [25]. It was concluded that earlier studies may have overestimated the prevalence and duration of these symptoms, showing their progressive resolution within three to six months.…”