Brief Report: Chikungunya Viral Arthritis in the United States: A Mimic of Seronegative Rheumatoid Arthritis

Abstract

OBJECTIVE Chikungunya virus (CHIKV) is an arthritogenic mosquito-transmitted alphavirus that spread to the Caribbean in 2013 and the United States in 2014. CHIKV-infected patients develop inflammatory arthritis that can persist for months to years, but little is known about the rheumatologic and immunologic features of CHIKV arthritis in humans, particularly as compared to rheumatoid arthritis (RA). Here, we describe these features in a group of 10 American travelers who were nearly simultaneously infected while visiting Haiti in June 2014. METHODS Patients were assessed by history, physical examination, and laboratory studies. All patients with CHIKV arthritis had detectable anti-CHIKV IgG. Using cytometry by time of flight (CyTOF), we analyzed peripheral blood mononuclear cells in CHIKV-infected patients, healthy controls, and patients with untreated, active RA. RESULTS Among ten CHIKV-infected individuals, eight developed persistent symmetric polyarthritis, who otherwise met the 2010 ACR/EULAR criteria for (seronegative) RA. CyTOF analysis revealed that RA and CHIKV-infected patients had greater percentages of activated and effector CD4+ and CD8+ T cells than healthy controls. CONCLUSION In addition to similar clinical features, patients with CHIKV infection and RA develop highly similar peripheral T cell phenotypes. These overlapping clinical and immunologic features highlight a need for rheumatologists to consider CHIKV infection when evaluating patients with new, symmetric polyarthritis.

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

“…In a recent study, eight of ten patients with chronic symmetric polyarthritis due to CHIK V also met criteria for RA based on the 2010 American College of Rheumatology/European League Against Rheumatism criteria, highlighting the overlapping clinical features of the two diseases. 15 Although three of the eight patients had positive antinuclear antibodies, none had rheumatoid factor or anti-cyclic citrullinated protein antibodies. 15 The acute onset (within hours) of widespread severe arthralgias in CHIKV can differentiate it from RA, underscoring the importance of history in the diagnosis.…”

“…15 Although three of the eight patients had positive antinuclear antibodies, none had rheumatoid factor or anti-cyclic citrullinated protein antibodies. 15 The acute onset (within hours) of widespread severe arthralgias in CHIKV can differentiate it from RA, underscoring the importance of history in the diagnosis. 15 The number of cases of CHIKV may actually be underestimated due to the difficulty of diagnosis.…”

“…15 The acute onset (within hours) of widespread severe arthralgias in CHIKV can differentiate it from RA, underscoring the importance of history in the diagnosis. 15 The number of cases of CHIKV may actually be underestimated due to the difficulty of diagnosis. The gold standard remains virus isolation, but this is seldom used.…”

Outbreak of Chikungunya Virus Infection with Global Propagation

“…Moreover, CHIKV infected and RA patients had greater percentages of activated and effector CD4 + and CD8 + T cells than healthy controls. 7 It is worth mentioning that the musculoskeletal manifestations of disease have been shown to affect 4-75% of those infected with CHIKV. 5 These figures vary widely depending on baseline genetic susceptibility of populations and cultural perceptions.…”

“…These use reverse transcriptase PCR assays to amplify fragments of the CHIKV genome and can be used to quantify fragments in real time. 7 Serological assays use ELISAs that capture IgM and IgG, immunofluorescence and immunoblot assays for CHIKV proteins. More recently a rapid immunochromatographic test (ICT) has been developed that can detect CHIKV, best used in the first 5 days of illness, and would allow rapid diagnosis at the point of care.…”