SAT0399 Chikungunya fever in karachi: clinical and laboratory features and factors associated with persistent arthralgia

Abstract

BackgroundChikungunya virus (CHIKV) is an alphavirus transmitted by mosquito vectors.1 Acute infection lasts for 1–10 days and is characterised by abrupt onset of fever and severe arthralgia. Painful polyarthralgia is the symptom causing serious economic and social impacts on individuals and the affected communities.2 In a study conducted by Schilte C et al, 60% of CHIKV-infected patients suffered from arthralgia, 36 months after acute infection[.3 Non-salicylate analgesics and non-steroidal anti-inflammatory drugs (NSAIDS) are most commonly used for symptomatic relief.4 There is lack of local data on CHIKV and it’s after effects. By determining the clinical and laboratory features associated with CHIKV and persistent arthralgia, it will help us in early diagnosis, and improved outcomes in our population.ObjectivesTo study clinical and laboratory features associated with persistent arthralgia in patients with chikungunya feverMethodsThis observational study was conducted at the Rheumatology Clinic of Liaquat National Hospital, Karachi. It comprised of collected data of patients who presented with arthralgias and positive chikungunya serology. Detailed history, examination and laboratory investigations were recorded in a pre-designed structured proforma and SPSS21 was used for statistical analysis.ResultsWe had 52 patients out of which 28.8% were males and 71.2% were female, mean age being 45±5 years. Mean duration of arthralgia was 2.6 months. Pre-existing rheumatologic conditions were RA in 1.9% while SLE in 1.9% of the patients. Out of the total 9.6% were hospitalised due to complications like encephalitis, septic arthritis. Symmetrical arthralgia and asymmetrical was described in 76.9% and 23.1% of cases respectively. Small joint involvement was in 21.2%, large joint in 20.8% while both small and large involvement was seen in 48.1% of patients. Morning stiffness of greater than ½ hour was described in 63.5% of cases. Elevated ESR, CRP was seen in 69.2% and 59.6% cases, respectively. Patients were either given NSAIDs (34.6%), steroids (57.7%), or both (7.7%). Steroid was usually given in the form of a single intra muscular methylprednisolone 120 mg dose. In total 85.7% of patients improved after receiving steroids. While in group receiving NSAIDS only, improvement was seen 7.1% of total cases, and persistent arthralgia was seen in 88.9% of same group.ConclusionsChikungunya viral arthralgia has constituted a major disease and socioeconomic burden in our society in a relatively short span of time. Studies including our show it to be a great mimicker of inflammatory arthritis, and stresses the need to differentiate it, as history, clinical examination and lab parameters show quite similarity. Prompt treatments through steroids have shown great response in symptoms.References[1] Singhand SK, Unni SK. “Chikungunyavirus:hostpathogen interaction,”Reviews in Medical Virology2011;21(2):78–88.[2] Juppand PG, McIntosh BM. “Chikungunyavirusdisease,” in The Arboviruses: Epidemiology and Ecology, T. P. Monath, Ed., pp.137–157...

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“…3 Non-salicylate analgesics and non-steroidal anti-inflammatory drugs (NSAIDS) are most commonly used for symptomatic relief. 4 There is lack of local data on CHIKV and it's after effects. By determining the clinical and laboratory features associated with CHIKV and persistent arthralgia, it will help us in early diagnosis, and improved outcomes in our population.…”