Specific Management of Post-Chikungunya Rheumatic Disorders: A Retrospective Study of 159 Cases in Reunion Island from 2006-2012

Abstract

BackgroundSince 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients.Patients and methodsWe conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria.ResultsWe reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy.ConclusionRheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.

Chikungunya Fever in Japan Imported from the Caribbean Islands

“…Therefore, it is important to consider that the epidemic Asian genotypes could be a causative pathogen for PCCA. Based on the observation of the outbreak of the ECSA genotype in La Reunion Islands in 2005 to 2006, RF and anti-CCP antibodies could be detected in 12.5-57.1z and 28.6-56.5z of patients with PCCA, respectively (14,16,17). In our case, not only RF but also IgG-RF could be detected in the early chronic phase, within 2 weeks of the onset of clinical symptoms.…”

Chikungunya

“…Most studies involved a small number of patients, and different methodologies were used; thus, it is currently impossible to draw conclusions regarding the efficacy of these drugs, or to assess the superiority of different therapies in patients with chronic Chikungunya. 60,61,62,63 The use of these drugs is based on extrapolation from their use in the treatment of chronic rheumatic diseases. 3,53,60,61,62 For CHIK CIR the DMARD modality should be come at first as the destruction can be prevented early.…”

“…60,61,62,63 The use of these drugs is based on extrapolation from their use in the treatment of chronic rheumatic diseases. 3,53,60,61,62 For CHIK CIR the DMARD modality should be come at first as the destruction can be prevented early. For RA and SA, The treatment modalities are well defined for both diseases, methotrexate has a special position.…”

That Which Bends Up: A Case Report and Literature Review of Chikungunya Virus

“…19 For patients with refractory or relapsing symptoms, glucocorticoids and physical therapy have shown some benefit. 2,20 Duration of treatment is individualized to the duration of symptoms.…”