Stiffness, pain, and joint counts in chronic chikungunya disease: relevance to disability and quality of life

Abstract

Introduction/Objectives-To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms.Method-Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact.Results-Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS

Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil

“…Similar to the present results, a systematic review including different study designs (from cohort to case series, cross-sectional and case-control investigations) and comprising >6500 patients with chikungunya found that 42% (95% CI 33-51%) of these cases did not recover fully from persistent pain/arthralgia after 3 months (Paixão et al, 2018). Specifically among cohort studies, the rate of chronic arthralgia after CHIKV infection has been reported to range from 22% to 67% (Borgherini et al, 2008;Gérardin et al, 2013;Madec et al, 2013;van Genderen et al, 2016;Zeana et al, 2016;Murillo-Zamora et al, 2017;Huits et al, 2018;Watson et al, 2020). The large difference in the time elapsed between acute disease stage and patient follow-up, as well as the subjectivity in pain perception and reporting, may explain, in part, the diverse estimates of risk for development of chronic arthralgia.…”

“…In this stage, arthralgia typically affects multiple joints in a relapsing-remitting or persistent pattern (Weaver and Lecuit, 2015). Other common symptoms of chronic chikungunya include joint stiffness, oedema and redness (Consuegra-Rodríguez et al, 2018;Watson et al, 2020).…”

Arthralgia resolution rate following chikungunya virus infection

“…Arthralgia is the hallmark of chronic CHIKV disease. Whether continuous in nature or following a relapsing-remitting pattern, this debilitating joint pain is associated with significant disability and impaired quality of life (Elsinga et al 2017;Watson et al 2020). To-date, no commercial vaccine or specific antiviral drugs exist for the prevention or treatment of infection with CHIKV, with clinical management primarily focused on the relief of symptoms.…”

In-depth characterization of a novel live-attenuated Mayaro virus vaccine candidate using an immunocompetent mouse model of Mayaro disease

“…Chronic joint inflammation and pain are the hallmarks of disease in patients with alphavirus infections 27,45 . Pain is one of the classical signs of the inflammatory process in which sensitization of the nociceptors is the common denominator 46 .…”