Treatment of chikungunya chronic arthritis: A systematic review / Tratamento de artralgia crônica da chikungunya: uma revisão sistemática

Summary Introduction: Chikungunya (CHIK) is a tropical arbovirus, transmitted by the female mosquito Aedes aegypti and Aedes albopictus. In Brazil, there have been cases reported since 2014. The initial manifestations of this virus are sudden onset high fever, headache, chills, rashes, myalgia and intense joint pain. Usually, CHIK presents the acute and chronic phases, the latter characterized by bilateral polyarthralgia, which can last for months or even years. During this period, autoimmune diseases can be triggered, making the picture even more complicated. Method: A systematic review was performed on the PubMed and Scielo databases in January 2017. Clinical trials, cohorts, case-control and case reports were included in the study. Expert opinions, societal consensuses and literary reviews were exclusion criteria. Studies were conducted in English, Spanish and Portuguese. The studies were descriptively analyzed and the data was grouped according to methodological similarity. Results: Twenty-four (24) articles were selected and, in compliance with the inclusion and exclusion criteria, 18 were eliminated, with six studies remaining in the present review: five clinical trials and one case report. Conclusion: When the manifestations of CHIK become chronic and, the longer they last, more complications arise. Polyarthralgia can be immaterial, distancing individuals from their daily-life activities. Anti-inflammatory drugs (either steroid or not), in addition to immunosuppressants, homeopathy and physiotherapy are measures of treatment that, according to the literature, have been successful in relieving or extinguishing symptoms. However, it is fundamental that studies of CHIK treatment be further developed.

Resumo Introdução: A chikungunya é uma arbovirose tropical, transmitida pela fêmea dos mosquitos Aedes aegypti e Aedes albopictus. No Brasil, existem casos relatados desde 2014. As manifestações iniciais dessa virose são: febre alta de início súbito, cefaleia, calafrios, erupções cutâneas, mialgia e dor articular intensa. Normalmente, a chikungunya apresenta as fases aguda e crônica, sendo a última caracterizada pela poliartralgia bilateral, que pode durar meses e até anos. Durante esse período, doenças autoimunes podem ser desencadeadas, tornando o quadro ainda mais complicado. Método: Foi realizada uma revisão sistemática nos bancos de dados PubMed e Scielo em janeiro de 2017. Ensaios clínicos, coortes, casos-controle e relatos de caso foram incluídos na pesquisa. Opiniões de especialista, consensos de sociedades e revisões literárias foram critérios de exclusão. Foram avaliados estudos nas línguas inglesa, espanhola e portuguesa. Os estudos foram analisados descritivamente, e os dados agrupados, conforme semelhança metodológica. Resultados: Foram selecionados 24 artigos; em obediência aos critérios de inclusão e exclusão, 18 foram eliminados, restando seis estudos na presente revisão: cinco ensaios clínicos e um relato de caso. Conclusão: Quando as manifestações da chikungunya se tornam crônicas, quanto mais tempo duram, mais complicações surgem. A poliartralgia pode ser incapacitante, afastando os indivíduos das suas atividades de vida diária. Anti-inflamatórios (esteroides ou não), somados a imunossupressores, homeopatia e fisioterapia são medidas de tratamento que, conforme a literatura, têm alcançado êxito no alívio ou na extinção dos sintomas. Todavia, é fundamental que os estudos do tratamento da chikungunya sejam mais aprofundados.

Poliartritis agudas virales / Viral acute polyarthritis

Las poliartritis agudas son cuadros de menos seis semanas de duración, cuyas causas pueden o no ser infecciosas. Entre las primeras, destacan las virales, con gran varie-dad de agentes causales. Entre ellos se distinguen por su frecuencia: virus hepatitis B,virus hepatitis C, parvovirus B19, virus rubéola y la fiebre Chicungunya. Tienen elementos comunes, como su expresión poliarticular, generalmente simétrica, con predilección por las pequeñas articulaciones de las manos, siendo habitualmente autolimitadas. A su vez, poseen elementos propios, clínicos y de laboratorio, que permiten diferenciarlos, teniendo algunos una evolución más agresiva con morbilidad más significativa. A su vez, por sus características clínicas y de laboratorio, plantean el diagnóstico diferencial con enfermedades inmunoreumatológicas, como la artritis reumatoidea y el lupus eritematoso sistémico, entre otras.Se realiza una revisión del cuadro clínico y de laboratorio de las poliartritis causadas por los virus señalados, su diagnóstico diferencial y posibilidades terapéuticas.

The acute polyarthritis are pictures of less six weeks duration, whose causes can be or not to be infectious. Among the first, the viral ones stand out with a variety of causal agents. Among there distinguished by their frequency: virus hepatitis B, hepatitis C virus, parvovirus B19, rubella virus and the fever Chicungunya. They have common elements, such as his expression polyarticular, usually symmetrical, with a predilection for the small joints of the hands, being usually self-limiting. At the same time, they have own laboratory and clinical elements that allow differentiation, some having a more aggressive evolution with more significant morbidity. At the same time, for its clinical and laboratory characteristics, raise the differential diagnosis of immunohematological diseases, such as arthritis rheumatoid and systemic lupus erythematosus among others.Is done a review of clinical and laboratory of the polyarthritis caused by the mentioned viruses, differential diagnosis and therapeutic possibilities.

A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint

Abstract: Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Fiebre de Chikungunya: reporte de tres casos del Hospital Naval Almirante Nef / Chikungunya fever: report of three cases from Almirante Nef Naval Hospital

Chikungunya fever is an emerging infection in our country due to travelers to endemic areas. It presents acutely with high fever, fatigue, headache, myalgia, skin rash and arthritis, usually as a symmetric polyarthritis compromising the interphalangeal and metacarpophalangeal joints, wrist, elbow, ankle and knee. While most of the symptoms last about a week, arthralgias may become chronic and generate significant functional impairment. Chikungunya has been postulated as a triggering factor for rheumatoid arthritis because of the presence of positive rheumatoid factor. We present the three confirmed cases in Almirante Nef Naval Hospital with the review of the published literature...

La fiebre de Chikungunya es una infección novedosa en nuestro país pues su contagio se produce por viajeros en zonas endémicas. Se presenta generalmente en forma aguda con fiebre alta, astenia, cefalea, mialgia, rash cutaneo y artritis, mayoritariamente como poliartritis simétrica comprometiendo las articulaciones interfalángicas, metacarpofalángicas, muñecas, codos, tobillo y rodillas. Si bien la mayoría de los síntomas duran aproximadamente una semana, las artralgias pueden hacerse crónicas y generar un importante deterioro funcional. Se ha postulado que podría ser un factor gatillante de artritis reumatoide ante la presencia de factor reumatoideo positivo. A continuación se presentan los tres casos confirmados del Hospital Naval Almirante Nef junto a la revisión de la literatura publicada hasta el momento...