Rheumatic manifestations associated with Chikungunya virus infection: A study of 307 patients with 32-month follow-up (RHUMATOCHIK study).

OBJECTIVES: In the wake of the Chikungunya epidemic which struck Reunion Island in 2005 and 2006, we conducted a prospective, multicentre study (RHUMATOCHIK) whose main objective was analyse the characteristics and progression of rheumatic manifestations in patients with post-Chikungunya joint pain. METHODS: A cohort of 307 consecutively included patients underwent rheumatological examinations for pain secondary to Chikungunya virus infection. The long-term evaluation was conducted by telephone survey 1 and 2 years after the onset of the viral infection. RESULTS: At inclusion, mean age was 54 years (24-87) and 83.1% of the patients were female. Chronic joint pain was associated with synovitis in 64.2% of the patients, affecting primarily the wrists, the proximal interphalangeal joints of the fingers, and the ankles. Attempts to detect the viral genome in joint fluid (10 patients) and synovial tissue (6 patients) using the RT-PCR technique were repeatedly unsuccessful. With a mean follow-up of 32 months, joint pain persisted in 83.1% of the patients. Functional impairment, however, was moderate, with a HAQ score of 0.44±0.5. CONCLUSION: Chikungunya virus infection is frequently the cause of joint manifestations that can persist for several months, or even several years. In some cases, the clinical symptoms closely resemble those usually associated with rheumatoid arthritis. Further studies are necessary to improve the therapeutic management of these patients.

Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study.

INTRODUCTION: Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. METHODS: Three hundred and forty-six infected adults (age≥15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis. RESULTS: Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms. CONCLUSIONS: Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years.

OBJECTIVE: In 2005, after an epidemic infection of Chikungunya fever in islands in the Indian Ocean, infected patients exhibited severe musculoskeletal disorders. We report 21 cases of rheumatoid arthritis (RA) after Chikungunya infection that were diagnosed at a rheumatological centre in Reunion Island. METHODS: Patients were examined by the same rheumatologist from February 2006 to July 2007. Inclusion criteria were (1) Chikungunya infection confirmed by IgM and IgG antibodies, (2) RA according to ACR criteria, (3) no other definite diagnosis of arthritis and (4) persistent arthritis symptoms from the onset of viral infection to RA diagnosis. RESULTS: Twenty-one patients (13 females; mean age, 57+/-12 years) fulfilled the inclusion criteria. Eighteen patients (85.7%) had symmetric polyarthritis and three had oligoarthritis. The mean symptom duration was 10 months (range 4-18). The mean ESR was 40.7+/-28.1 mm/hr and C-reactive protein level 37+/-41 mg/l; 12 patients were positive for rheumatoid factor (57.1%), and six had anti-CCP antibodies (28.6%) and 14 HLA DRB1*04 or 01 alleles (66.6%). Radiographs of hands and feet of 12 patients showed erosions and/or joint space narrowing (JSN). During a mean follow-up of 27.6+/-6.4 months, all patients were treated with DMARDs including methotrexate (n=19) and TNF blockers (n=6). Structural damage progressed, with 17 cases of erosion and/or JSN at follow-up. CONCLUSION: We diagnosed RA in 21 patients with Chikungunya fever. The first symptoms occurred at the time of viral infection. Outcome was severe in most of the cases despite low rate of anti-CCP antibodies. These cases suggest a role of viral infection in RA initiation.