A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study

Abstract

Background Chikungunya virus (CHIKV) has caused worldwide epidemics that impose a major burden on health systems. Approximately half of infected individuals develop chronic debilitating arthralgia, affecting their quality of life. Here, we identified the relevant clinical and demographic variables in the acute phase of CHIKV infection prospectively linked to chronic arthralgia to elaborate a prognostic scoring system. Methods Acute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined <10 days of disease onset and followed for one year to evaluate for disease progression. Potential risk factors for chronic arthralgia were evaluated by multivariate analysis to develop a prognostic scoring system, which was subsequently tested in an independent validation cohort consisting of 42 individuals. Results A total of 107 out of 134 (80%) acute CHIKV-confirmed cases from the derivation cohort were reexamined one year after enrollment. Chronic arthralgia post-CHIKV infection was PLOS NEGLECTED TROPICAL DISEASES

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

“…The present study also found that women were at increased risk of chronic arthralgia (RR 1.79 adjusted for age), corroborating prior studies that had shown RRs or odds ratios for female gender ranging from 1.3 to 3.4 for >6 weeks of persistent arthralgia (Rodriguez-Morales et al, 2016;Huits et al, 2018), and from 2.9 to 5.9 for >1 year of pain (Huits et al, 2018;de Moraes et al, 2020). The higher risk for chronic pain observed among women may be due to both biological and psychosocial factors.…”

“…The lack of significance should be interpreted with caution as only a minority of the followed-up patients did not have arthralgia at enrolment (11%), or reported having either arthrosis (11%) or hypertension (16%) before the onset of chikungunya. Given the biological plausibility and the fact that prior studies have shown the severity of acute arthralgia and the presence of underlying osteoarthritis and hypertension as risk factors for chronic chikungunya arthralgia (Sissoko et al, 2009;de Moraes et al, 2020), it is possible that these associations are real but the present study did not have sufficient power to detect them at the level set for statistically significant associations. As most patients with acute chikungunya present arthralgia, and as the overall population, especially the elderly, are frequently affected by arthropathies and hypertension, these factors may contribute significantly to the occurrence of chronic chikungunya arthralgia.…”

Arthralgia resolution rate following chikungunya virus infection

“…We also found a younger median cohort age <40 years to be associated with a quicker rate of arthralgia resolution than those with a median age ≥40 years. The observed association of increased age as a risk factor for persisting post-CHIKV infection symptoms is supported by previous studies (Sissoko et al 2009;Moro et al 2012;Essackjee et al 2013;Schilte et al 2013;Yaseen et al 2014;Murillo-Zamora et al 2017;de Moraes et al 2020). It is important to note that only a minority of children were included in the 16 cohort studies (Table S1), making our estimates predominantly generalisable to adult populations.…”

Chikungunya Manifestations and Viremia in Patients Who Presented to the Fever Clinic at Bangkok Hospital for Tropical Diseases during the 2019 Outbreak in Thailand

“…The reason for this resurgence is not fully elucidated, but is believed to be multifactorial, such as increased vector susceptibility and perhaps climate change [ 6 , 61 , 62 ]. Though the illness is self-limiting, infection results in increased morbidity and atypical manifestation, often with increased severity and fatalities [ 36 , 37 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ]. Chikungunya virus causes similar clinical manifestations during the acute phase that could mimic other arboviruses, and there are no widely available point-of-care rapid diagnostics [ 43 , 71 , 72 ].…”