Chikungunya virus (CHIKV)
infection is a common cause of febrile
arthritis. The most common manifestations of acute
infection are
fever, symmetrical
polyarthralgias or
polyarthritis, myalgias, and maculopapular
rash. Up to 80% of patients may develop musculoskeletal manifestations that persist longer than 3 months, causing impairment in their quality of life. The most common chronic manifestations are persistent or relapsing-remitting
polyarthralgias,
polyarthritis, and myalgias. Fingers, wrists, knees, ankles, and toes are the most frequently involved, but proximal joints and axial involvement can occur in the chronic stage. Chronic manifestations of CHIKV
infection may resemble those of some autoimmune
connective tissue diseases. Furthermore, CHIKV
infection can cause
cryoglobulinemia and may induce
rheumatoid arthritis and seronegative
spondyloarthropathies in genetically susceptible individuals. The Centers for Disease Control and Prevention recommend
acetaminophen and non steroidal anti-inflammatory drugs for the acute rheumatic manifestations of CHIKV
infection. However, some studies suggest that low-dose
corticosteroids for about 1-2 months (depending on
clinical course) are beneficial in relieving acute rheumatic symptoms. Conversely,
hydroxychloroquine in combination with
corticosteroids or other disease modifying
anti-rheumatic drugs (DMARDs) has been successful in treating chronic rheumatic manifestations.
Methotrexate and
sulfasalazine (alone or in combination) have also been effective for chronic CHIKV
arthritis. Patients with CHIKV
infection should be closely monitored to identify those with chronic
arthritis who would benefit from a rheumatologic evaluation and early treatment with DMARDs.