Clinical Features and Management of Chronic Chikungunya Arthritis

Abstract

Chikungunya virus is a single-stranded RNA alphavirus transmitted to humans by Aedes species mosquitos, causing an acute illness known as chikungunya fever with maculopapular rash, headache, polyarthritis/arthralgias, and gastrointestinal symptoms. Up to half of affected patients develop a chronic disabling arthritis following resolution of the acute infection, which can last for months or even years. The pathophysiology of chronic chikungunya arthritis remains controversial; it may result from a dysregulated immune response or be caused by persistent viral infection. Treatment for patients with chronic chikungunya arthritis remains investigational. Limited data suggests that immunosuppressive therapies such as methotrexate and TNF alpha inhibitors may be beneficial, though randomized clinical trials are needed.

Multiple Factors Involved in Bone Damage Caused by Chikungunya Virus Infection

“…The treatment of acute cases produced by the virus is mainly oriented towards fever and joint pain control (Figure 2) [84]. In the case of bone erosion, which is produced by the chronic inflammation of destructive arthritis, drugs that are already used to treat other types of non-infectious arthritis have been studied [85][86][87][88].…”

Pentosan polysulfate sodium prevents functional decline in chikungunya infected mice by modulating growth factor signalling and lymphocyte activation

“…Non-steroidal anti-inflammatory drugs (NSAIDs) can also alleviate the inflammatory aspects of sub-acute and chronic disease however, long-term use of NSAIDs has unwanted side effects including gastric ulcers, cardiovascular complications, and renal impairment. Systemic corticosteroids are only recommended for patients presenting with chronic highly inflammatory polyarthritis but their use has been shown to increase the risk of developing infection, cataracts, glaucoma, diabetes and osteoporosis [ 12 ] and are contraindicated in acute CHIKV disease [ 13 ]. Given the extensive burden of CHIKV-induced rheumatic conditions and the complications of non-specific treatments currently available, there is an urgent need for a targeted therapeutic agent.…”