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

Abstract

The number of publications on the development of arthritic pain after CHIKV infection is increasing; however, there is still a gap in the pathophysiological mechanisms that explain these outcomes. In this review, we conducted a descriptive analysis of the findings of patients to understand their prognosis and to explore therapeutic options. Here, we searched the Cochrane, BVS, PubMed, and Scielo databases using the keywords “arthritis”, “pain”, “arbovirus”, “disease”, “arthritogenic”, and “arthralgia” during the 2000 to 2022 period. Descriptive analyses were conducted to understand the association between CHIKV infection and arthritogenic pain. The present study shows the persistence of acute phase signals for months, making the chronic phase still marked by the presence of arthralgia, often disabling under stimuli, such as temperature variation. CHIKV infection appears to be remarkably similar to rheumatoid arthritis, since both diseases share common symptoms. Once diagnosed, patients are mostly treated with analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARD). As there are no prophylactic measures or specific treatments for arboviruses, this study gathered information on the development and manifestations of arthritogenic pain.

Beyond the bite: understanding and managing post-arboviral pain

“…Studies in animal models and human patients have shown that CHIKV can persist in target tissues, such as joints, even after its elimination from the bloodstream. 7 , 9 This suggests that the continuous presence of the virus in tissues may trigger a chronic inflammatory response, contributing to persistent pain and progression to chronic arthritic syndrome. 7 , 9 , 10 However, the chronification of post-arboviral pain is still not fully understood, although evidence suggests it may be related to the persistence of viral RNA fragments or proteins in macrophages and monocytes, leading to cellular activation and subsequent cytokine and antibody production, as well as the induction of autoimmunity in genetically predisposed individuals.…”

“… 7 , 9 This suggests that the continuous presence of the virus in tissues may trigger a chronic inflammatory response, contributing to persistent pain and progression to chronic arthritic syndrome. 7 , 9 , 10 However, the chronification of post-arboviral pain is still not fully understood, although evidence suggests it may be related to the persistence of viral RNA fragments or proteins in macrophages and monocytes, leading to cellular activation and subsequent cytokine and antibody production, as well as the induction of autoimmunity in genetically predisposed individuals. 9 , 10 Prolonged immune cell activation and induction of autoimmunity in predisposed individuals may also contribute to symptom persistence.…”

“… 7 The specific mechanisms by which the virus persists in tissues and triggers a chronic inflammatory response are not yet fully understood and require further investigation. 4 , 9 …”

Emerging Diseases/Viruses Prevention, Control, Surveillance, and One Health

“…Another report studies the seroprevalence of DENV, ZIKV, or CHIKV in Bangphae District, Ratchaburi Province, Thailand, via enzyme-linked immunosorbent assays and rapid diagnostic tests [ 9 ]. Furthermore, one review details the role of CHIKV infection in arthritogenic pain, which appears to be comparable to rheumatoid arthritis as both diseases share common symptoms [ 10 ].…”