The ACR’s State-of-the-Art Clinical Symposium: Rheumatic, Malignant Disease Mimics Call for Diligence from Rheumatologists

A recent study out of Washington University—involving 10 patients who had traveled to Haiti in 2014 and were found to be positive for the virus—reported that eight of 10 developed arthritis that lasted at least six weeks and that all of them met 2010 ACR/EULAR criteria for RA, showing how difficult this viral illness can be to distinguish from RA.⁵ RF and CCP tests were negative in all of them.

A mass cytometry analysis of these patients, RA patients and healthy controls found similar NK and T cell profiles in both. But they found differences in the activated T killer cells compared to the healthy controls, and a trend toward higher L-selectin expression in CD4+ T cells in the RA patients.

“These preliminary data suggest that it may be possible to differentiate chronic Chikungunya virus arthritis from early rheumatoid arthritis,” Dr. Jonas said.

“We should be asking patients if they’ve come back from the Caribbean, the U.S. Virgin Islands or other locations where the virus is transmitted. Because the patient may present many weeks or months after their travel, physicians and patients might be not making the connection,” she said. “You have to have a high degree of suspicion.”

Thomas R. Collins is a freelance medical writer based in Florida.

References

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