Persistent Arthralgia and Related Risks Factors: A Cohort Study at 12 Months from Laboratory-Confirmed Chikungunya Infection

Abstract

To assess the cumulative incidence and clinical markers associated with persistent arthralgia (PA) at 12months from acute chikungunya virus (CHIKV) infection. A multicenter retrospective cohort study was conducted in the state of Colima, Mexico, and 217 serologically confirmed cases of CHIKV infection were enrolled. Participants aged 15years and older were interviewed on 6months basis from acute illness onset and the main binary outcome was self-reported PA at 12months. To assess clinical markers associated with PA we used a generalized linear model. The 2-item Patient Health Questionnaire (PHQ-2) was used to screen for depressive symptoms among PA-positive individuals. The cumulative incidence of PA was 31.8%. In the generalized linear model, individuals ≥40years of age (risk ratio (RR)=1.68; 95% confidence interval (CI), 1.10-2.55) and those with 8 or more arthralgia sites (RR=2.91, 95% CI 1.87-4.53) at acute disease had a significantly increased risk of PA at 12months from CHIKV infection. Self-reported arthralgia (any site) at 3months post-infection, a sub-chronic clinical marker, was also associated with a significantly increased risk of long-term articular manifestations (RR=7.06, 95% CI 2.97-16.81). Depressive symptoms (PHQ-2 score ≥3) were reported by 33.3% of PA-positive participants. Our findings suggest that chronic CHKV-related articular manifestations were a frequent event in the study sample and the impact on functional status was potential. These results may be useful in health care settings in the risk-stratification of PA after CHIKV infection.