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Chikungunya: What Every Rheumatologist Needs to Know

Dany V. Thekkemuriyil, MD  |  Issue: November 2014  |  

There has been only anecdotal evidence for the use of disease-modifying antirheumatic drugs in the chronic arthritic phase. A single, randomized, controlled study, comparing chloroquine with NSAIDs (meloxicam), failed to demonstrate any advantage of chloroquine over meloxicam.36

Active research is underway to develop a better vaccine and treatments for Chikungunya infection. Currently, prevention consists of minimizing mosquito exposure.

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Conclusion

Chikungunya continues to spread to different geographic areas and is a major threat with its ability to rapidly infect a large population. The debilitating severe chronic arthritis, which can present in a similar fashion to RA, is a serious concern for rheumatologists. In the U.S., the vectors transmitting dengue virus are only seen in the southern and southeastern states, but it has been demonstrated in the lab that it does not take long for viral mutation and mosquito adaptability to occur. Better understanding of the pathophysiogenesis is needed for developing treatment and preventive strategies. More randomized, controlled studies are needed to guide treatment approaches.

Dany V. Thekkemuriyil, MD, is a rheumatology fellow at Washington University in St. Louis. He saw Chikungunya during the outbreak in India.

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Chikungunya—Things to Note

  • Acute presentation is characterized by high-grade fevers, joint pain, rash.
  • Chronic persistent arthritis lasting months to years, which can present similar to RA.
  • Travel history and history of sick contacts is important.
  • Report suspected cases to the state or local health department.
  • Laboratory diagnosis: Serology to detect IgMif ≥4 days, IgG >2 weeks since onset (CDC). RT-PCR to detect viral RNA if in first week of illness.
  • Supportive treatment: fluids, analgesics, NSAIDs.

References

  1. Robinson MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952–53. I. Clinical features. Trans R Soc Trop Med Hyg. 1955 Jan;49(1):28–32.
  2. Lumsden WH. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952–53. II. General description and epidemiology. Trans R Soc Trop Med Hyg. 1955 Jan;49(1):33–57.
  3. Fischer M, Staples JE; Arboviral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Chikungunya virus spreads in the Americas—Caribbean and South America, 2013–2014. MMWR Morb Mortal Wkly Rep. 2014 Jun 6;63(22):500–501.
  4. Vega-Rua A, Zouache K, Girod R, et al. High level of vector competence of Aedes aegypti and Aedes albopictus from ten American countries as a crucial factor in the spread of Chikungunya virus. J Virol. 2014 Jun;88(11):6294–6306.
  5. Carey DE. Chikungunya and dengue: A case of mistaken identity? J Hist Med Allied Sci. 1971 Jul;26(3):243–262.
  6. Thiberville SD, Moyen N, Dupuis-Maguiraga L, et al. Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res. 2013 Sep;99(3):345–370.
  7. Staples JE, Breiman RF, Powers AM. Chikungunya fever: An epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009 Sep 15;49(6):942–948.
  8. Renault P, Solet JL, Sissoko D, et al. A major epidemic of chikungunya virus infection on Reunion Island, France, 2005–2006. Am J Trop Med Hyg. 2007 Oct;77(4):727–731.
  9. Sergon K, Njuguna C, Kalani R, et al. Seroprevalence of Chikungunya virus (CHIKV) infection on Lamu Island, Kenya, October 2004. Am J Trop Med Hyg. 2008 Feb;78(2):333–337.
  10. Chopra A, Anuradha V, Lagoo-Joshi V, et al. Chikungunya virus aches and pains: An emerging challenge. Arthritis Rheum. 2008 Sep;58(9):2921–2922.
  11. Krishnamoorthy K, Harichandrakumar KT, Krishna Kumari A, et al. Burden of chikungunya in India: Estimates of disability adjusted life years (DALY) lost in 2006 epidemic. J Vector Borne Dis. 2009 Mar;46(1):26–35.
  12. Charrel RN, de Lamballerie X, Raoult D. Seasonality of mosquitoes and chikungunya in Italy. Lancet Infect Dis. 2008 Jan;8(1):5–6.
  13. Rulli NE, Suhrbier A, Hueston L, et al. Ross River virus: Molecular and cellular aspects of disease pathogenesis. Pharmacol Ther. 2005 Sep;107(3):329–342.
  14. Pialoux G, Gauzere BA, Jaureguiberry S, et al. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis. 2007 May;7(5):319–327.
  15. Bordi L, Carletti F, Castilletti C, et al. Presence of the A226V mutation in autochthonous and imported Italian chikungunya virus strains. Clin Infect Dis. 2008 Aug 1;47(3):428–429.
  16. Schuffenecker I, Iteman I, Michault A, et al. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med. 2006 Jul;3(7):e263.
  17. Tsetsarkin KA, Vanlandingham DL, McGee CE, et al. A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog. 2007 Dec;3(12):e201.
  18. Vega-Rua A, Zouache K, Girod R, et al. High level of vector competence of Aedes aegypti and Aedes albopictus from ten American countries as a crucial factor in the spread of Chikungunya virus. J Virol. 2014 Jun;88(11):6294–6306.
  19. Devaux CA. Emerging and re-emerging viruses: A global challenge illustrated by Chikungunya virus outbreaks. World J Virol. 2012 Feb 12;1(1):11–22.
  20. Reiskind MH, Pesko K, Westbrook CJ, et al. Susceptibility of Florida mosquitoes to infection with chikungunya virus. Am J Trop Med Hyg. 2008 Mar;78(3):422–425.
  21. Reiter P, Fontenille D, Paupy C. Aedes albopictus as an epidemic vector of chikungunya virus: Another emerging problem? Lancet Infect Dis. 2006 Aug;6(8):463-464.
  22. Rochlin I, Ninivaggi DV, Hutchinson ML, et al. Climate change and range expansion of the Asian tiger mosquito (Aedes albopictus) in Northeastern USA: Implications for public health practitioners. PLoS One. 2013;8(4):e60874.
  23. Fourie ED, Morrison JG. Rheumatoid arthritic syndrome after chikungunya fever. S Afr Med J. 1979 Jul 28;56(4):130–132.
  24. Lynch N, Ellis Pegler R. Persistent arthritis following Chikungunya virus infection. N Z Med J. 2010 Oct 15;123(1324):79–81.
  25. Brighton SW. Chloroquine phosphate treatment of chronic Chikungunya arthritis. An open pilot study. S Afr Med J. 1984 Aug 11;66(6):217–218.
  26. Bouquillard E, Combe B. Rheumatoid arthritis after Chikungunya fever: A prospective follow-up study of 21 cases. Ann Rheum Dis. 2009 Sep;68(9):1505–1506.
  27. Manimunda SP, Vijayachari P, Uppoor R, et al. Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging. Trans R Soc Trop Med Hyg. 2010 Jun;104(6):392–399.
  28. Chaaithanya IK, Muruganandam N, Raghuraj U, et al. Chronic inflammatory arthritis with persisting bony erosions in patients following chikungunya infection. Indian J Med Res. 2014 Jul;140(1):142–145.
  29. Queyriaux B, Simon F, Grandadam M, et al. Clinical burden of chikungunya virus infection. Lancet Infect Dis. 2008 Jan;8(1):2–3.
  30. Simon F, Javelle E, Oliver M, et al. Chikungunya virus infection. Curr Infect Dis Rep. 2011 Jun;13(3):218–228.
  31. Mohan A, Kiran DH, Manohar IC, et al. Epidemiology, clinical manifestations, and diagnosis of Chikungunya fever: Lessons learned from the re-emerging epidemic. Indian J Dermatol. 2010;55(1):54–63.
  32. Gerardin P, Barau G, Michault A, et al. Multidisciplinary prospective study of mother-to-child chikungunya virus infections on the island of La Réunion. PLoS Med. 2008 Mar 18;5(3):e60.
  33. Hoarau JJ, Jaffar Bandjee MC, Krejbich Trotot P, et al. Persistent chronic inflammation and infection by Chikungunya arthritogenic alphavirus in spite of a robust host immune response. J Immunol. 2010 May 15;184(10):5914–5927.
  34. de Lamballerie X, Ninove L, Charrel RN. Antiviral treatment of chikungunya virus infection. Infect Disord Drug Targets. 2009 Apr;9(2):101–104.
  35. Labadie K, Larcher T, Joubert C, et al. Chikungunya disease in nonhuman primates involves long-term viral persistence in macrophages. J Clin Invest. 2010 Mar;120(3):894–906.
  36. Chopra A, Saluja M, Venugopalan A. Effectiveness of chloroquine and inflammatory cytokine response in patients with early persistent musculoskeletal pain and arthritis following chikungunya virus infection. Arthritis Rheumatol. 2014 Feb;66(2):319–326.

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