Prevalence of Chronic Joint Pain following Chikungunya Infection from a Colombian Cohort.

Introduction: Chikungunya fever is a viral illness spread by mosquitos. The infection presents with fever, headache, muscle pain, rash, and joint pain. Outbreaks have previously been restricted to Africa, Asia, Europe, and islands in the Indian and Pacific Oceans,1 causing chronic arthritis lasting months to years in these areas. In 2013, Chikungunya virus was found for the first time in the Americas, on islands in the Caribbean, and has now infected over 800,000 people. The primary objective of this study was to determine the prevalence of chronic arthritis after chikungunya infection in a Latin American cohort and define the clinical characteristics associated with chronic arthritis symptoms. Methods: 494 Colombian patients with serologically confirmed Chikungunya were included in the study. Patients received a baseline symptom questionnaire and a 20-month telephonic follow-up symptom questionnaire. Comparisons of the reported symptoms were analyzed using chi-square or the Kruskal-Wallis. Results: The baseline characteristics of the patients include mean age 49 +/- 17 years, 81% female, 94% Mestizo ethnicity, and 76% with high school or less education. Common comorbidities seen in the study sample were hypertension, diabetes, lung disease and depression. 25% of the patients reported current, persistent joint pain at 20-month follow-up, The patients with persistent joint pain in weeks had increased duration of initial joint pain (40.2 ± 37.7) compared to the no persistent joint pain group (11.4 ± 26.3) with p\u3c0.0001. Of the 70 patients that missed work/school, 44 patients had persistent joint pain (p\u3c0.001), and of the 32 patients that had symptoms impact their capacity to continue normal activity, 24 had chronic joint pain (p\u3c0.001). Patients with persistent joint pain had increased disease activity of swollen joint count (0.5 ± 1.0) and tender joint count (3.0 ± 2.3) compared to the no persistent joint pain groups (0.04 ± 0.3, 0.2 ± 0.8, respectively) with p\u3c0.0001. Conclusion: Chikungunya caused significant debilitating chronic arthritis in quarter of the patients at 20-months post infection. Future Analysis: The baseline cytokine profile of cases of chikungunya arthritis in comparison to age and gender matched controls from the same cohort without persistent arthritis will be evaluated to further understand the development chikungunya arthritis and the biomarkers that may predict persistent arthritis

Frequency of Chronic Joint Pain Following Chikungunya Virus Infection

ObjectiveTo estimate the frequency of chronic joint pain after infection with chikungunya virus in a Latin American cohort.MethodsA cross-sectional follow-up of a prospective cohort of 500 patients from the Atlántico Department, Colombia who were clinically diagnosed as having chikungunya virus during the 2014-2015 epidemic was conducted. Baseline symptoms and follow-up symptoms at 20 months were evaluated in serologically confirmed cases.ResultsAmong the 500 patients enrolled, 485 had serologically confirmed chikungunya virus and reported joint pain status. Patients were predominantly adults (mean ± SD age 49 ± 16 years) and female, had an education level of high school or less, and were of Mestizo ethnicity. The most commonly affected joints were the small joints, including the wrists, ankles, and fingers. The initial virus symptoms lasted a median of 4 days (interquartile range [IQR] 3-8 days). Sixteen percent of the participants reported missing school or work (median 4 days [IQR 2-7 days]). After 20 months, one-fourth of the participants had persistent joint pain. A multivariable analysis indicated that significant predictors of persistent joint pain included college graduate status, initial symptoms of headache or knee pain, missed work, normal activities affected, ≥4 days of initial symptoms, and ≥4 weeks of initial joint pain.ConclusionThis is the first report to describe the frequency of chikungunya virus-related arthritis in the Americas after a 20-month follow-up. The high frequency of chronic disease highlights the need for the development of prevention and treatment methods

Frequency of chronic joint pain following chikungunya virus infection: a colombian cohort study

Objective To estimate the frequency of chronic joint pain after infection with chikungunya virus in a Latin American cohort. Methods A cross‐sectional follow‐up of a prospective cohort of 500 patients from the Atlántico Department, Colombia who were clinically diagnosed as having chikungunya virus during the 2014–2015 epidemic was conducted. Baseline symptoms and follow‐up symptoms at 20 months were evaluated in serologically confirmed cases. Results Among the 500 patients enrolled, 485 had serologically confirmed chikungunya virus and reported joint pain status. Patients were predominantly adults (mean ± SD age 49 ± 16 years) and female, had an education level of high school or less, and were of Mestizo ethnicity. The most commonly affected joints were the small joints, including the wrists, ankles, and fingers. The initial virus symptoms lasted a median of 4 days (interquartile range [IQR] 3–8 days). Sixteen percent of the participants reported missing school or work (median 4 days [IQR 2–7 days]). After 20 months, one‐fourth of the participants had persistent joint pain. A multivariable analysis indicated that significant predictors of persistent joint pain included college graduate status, initial symptoms of headache or knee pain, missed work, normal activities affected, ≥4 days of initial symptoms, and ≥4 weeks of initial joint pain. Conclusion This is the first report to describe the frequency of chikungunya virus–related arthritis in the Americas after a 20‐month follow‐up. The high frequency of chronic disease highlights the need for the development of prevention and treatment methods

Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms

OBJECTIVE: To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. METHODS: A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. RESULTS: Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. CONCLUSION: To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis