Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

Abstract

Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).

Serum metabolomics analysis of patients with chikungunya and dengue mono/co-infections reveals distinct metabolite signatures in the three disease conditions

“…Geriatric population has been reported to be affected in a more pronounced manner with a prolonged chronic phase as compared to individuals of younger age affected by the infection31. Our sample cohort in the present study also revealed that the median age was the maximum in case of CHIK (Table 1).…”

Therapy with CTLA4-Ig and an antiviral monoclonal antibody controls chikungunya virus arthritis

“…The worldwide emergence of CHIKV has created a need to identify treatments, as epidemiological estimates suggest there are millions suffering from acute arthritis and at least ~400,000 people in the Western Hemisphere suffering from chronic CHIKV arthritis (5, 8). We reasoned that established therapies used to treat other forms of inflammatory arthritis (for example, rheumatoid or psoriatic arthritis) also might mitigate CHIKV arthritis.…”

“…CHIKV and other arthritogenic alphaviruses directly invade the synovium to cause inflammatory arthritis (4), which is characterized by articular swelling and prolonged morning stiffness (3). CHIKV-induced arthritis in humans can persist, with as many as 60% of individuals progressing to chronic disease that lasts from months to years (3, 5–7). Epidemiological projections suggest that there are currently about 400,000 individuals in the Western Hemisphere with chronic CHIKV arthritis (8).…”

Persistent Arthralgia Associated with Chikungunya Virus Outbreak, US Virgin Islands, December 2014–February 2016

“…However, 7%–79% of case-patients from previous outbreaks have reported persistent arthralgia for months after infection ( 4 – 8 ). Persistent arthralgia associated with CHIKV illness has been assessed in persons in Southeast Asia, South America, and Europe but not in the Caribbean ( 4 , 9 ). …”