Successful Methotrexate Treatment of Chronic Chikungunya Arthritis

Amaral, J. Kennedy; Bingham, Clifton O.; Schoen, Robert T.

doi:10.1097/rhu.0000000000000943

Cited by 16 publications

(20 citation statements)

References 34 publications

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“…Our patients, 90% of whom were self-referred, experienced chronic pain and disability prior to evaluation in our clinic. The mean time between the onset of CHIKF and the first visit to us was 14.2 months, similar to the delays of 8 months to 2 years in treatment of CCA reported elsewhere [41]. Thirty of our patients (60%) had arthralgia while 20 patients (40%) also had arthritis, with clinically evident synovitis (Figure 1).…”

Section: Chronic Chikungunya Arthritissupporting

confidence: 83%

“…Recently in our clinic, we evaluated a cohort of 50 Brazilian patients seen with CCA that we defined as arthritis/arthralgia, persisting for more than 3 months after the onset of CHIKF [41]. Our patients, 90% of whom were self-referred, experienced chronic pain and disability prior to evaluation in our clinic.…”

Section: Chronic Chikungunya Arthritismentioning

confidence: 99%

“…Morning stiffness, low back pain, and neck pain were reported by 3 (6%), 8 (16%), and 3 (6%) patients, respectively. The ACR criteria for RA were met by 11 (22%) of the patients, and another 7 (14%) met the criteria for FM [41].…”

Section: Chronic Chikungunya Arthritismentioning

confidence: 99%

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The Clinical Features, Pathogenesis and Methotrexate Therapy of Chronic Chikungunya Arthritis

Amaral

Taylor

Teixeira

et al. 2019

Viruses

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Chikungunya fever (CHIKF) is an emerging viral infection that has spread widely, along with its Aedes vectors, throughout the tropics and beyond, causing explosive epidemics of acute illness and persistent disabling arthritis. The rheumatic symptoms associated with chikungunya virus (CHIKV) infection include polyarthralgia, polyarthritis, morning stiffness, joint edema, and erythema. Chronic CHIK arthritis (CCA) often causes severe pain and associated disability. The pathogenesis of CCA is not well understood. Proposed hypotheses include the persistence of a low level of replicating virus in the joints, the persistence of viral RNA in the synovium, and the induction of autoimmunity. In this review, we describe the main hypotheses of CCA pathogenesis, some of which support methotrexate (MTX) treatment which has been shown to be effective in preliminary studies in CCA.

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Section: Chronic Chikungunya Arthritissupporting

confidence: 83%

Section: Chronic Chikungunya Arthritismentioning

confidence: 99%

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The Clinical Features, Pathogenesis and Methotrexate Therapy of Chronic Chikungunya Arthritis

Amaral

Taylor

Teixeira

et al. 2019

Viruses

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“…At the first visit, the mean value for pain by visual analog scale was 7.7 ± 2.0. The mean values for pain at 4 and 8 weeks, compared to baseline, decreased to 3.0 and 2.6 respectively [24].…”

Section: Methotrexatementioning

confidence: 87%

“…The classical pattern of arthritis involves the small-to-medium sized joints in a peripheral and symmetric distribution [24]. This pattern can resemble rheumatoid arthritis (RA).…”

Section: Chronic Chikungunya Arthritismentioning

confidence: 99%

Clinical Features and Management of Chronic Chikungunya Arthritis

Bilsborrow¹,

Amaral²,

Schoen³

2019

Current Topics in Neglected Tropical Diseases

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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.

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