ABSTRACT
BACKGROUND: Chikungunya virus (CHIKV) is a mosquito- borne alphavirus of the family Togaviridae transmitted to humans by the Aedes spp. mosquitoes, causing Chikungunya Fever (CHIKF).OBJECTIVE: This study aims to describe the course and outcome of musculoskeletal (MSK) manifestations in patients with CHIKF seen over a three-month period.DESIGN: This is a prospective descriptive study. Seventy patients with fever, rash, and arthritis seen at the University of the Philippines-Philippine General Hospital and private arthritis clinics were collected from August - December 2012. Demographics and course of arthritis were described.RESULTS: Seventy patients, 53 (68.6%) female, with a mean age of 39.2 ±13.50 were diagnosed with CHIKF. All cases were from the Metropolitan Manila area. Of these, 15 (21.4%) had family members affected. Twenty-four patients (34.3%) were either employed or students. The most common presenting symptoms were fever (94.3%), arthritis or athralgia (98.6%), and rash (87.1%). The most common joint areas involved were the ankles (60.0%), the wrists (40.0%) and the small joints of the hand (51.4%). Twenty-seven (47.3%) had symmetric arthritis. Thirty- seven cases (52.9%) had arthralgia or arthritis for at least six weeks. By the end of the follow-up period, only four (5.7%) had persistent musculoskeletal symptoms. Age and sex were not found to be factors in determining chronicity of arthritic symptoms (p = 0.104 and p=0.58 respectively). Of the seventy patients, 31 (44. 3%) were confirmed cases of CHIKF-- 29 had (+) CHIKV IgM by ELISA, and two had (+) CHIKV PCR. Twenty- one (67.7%) had persistent arthritis of at least six weeks. Treatment consisted of continuous NSAIDs for at least two weeks and some received steroids. In this subgroup, age and sex were not shown to correlate with chronic arthritis (p=0.47 and p=0.05 respectively).CONCLUSION: This report on a recent outbreak of CHIKF showed the classic triad of fever, rash, and arthritis. There was no correlation between age and chronicity of arthritic symptoms. Sex, likewise, did not appear to influence chronicity. The disease occurred in family clusters. Patients required continuous treatment with NSAIDs and some had to be given steroids. Most cases resolved by 12 weeks.