Abstract
IntroductionLong-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R.MethodsThree hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis.ResultsOf these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms.ConclusionsOur data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.
Highlights
Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R)
CHIKV infection often leads to prolonged joint pain, which may harbour two different tempos; either a continuous burden or relapse attacks that characterize the hallmark of Chikungunya rheumatism (CHIK-R) [6,7,8,9]
Here we report a prognostic survey of CHIK-R based on the subset of participants reporting RMSP at the onset of CHIKV infection, who were extracted from the TELECHIK cohort study, a population based-study aimed at assessing the disease burden and perceived morbidity in La Réunion island community after the 2005 to 2006 CHIKV outbreak [24]
Summary
Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. CHIKV might trigger or reveal inflammatory rheumatic diseases (IRDs) such as rheumatoid-like arthritis (RA) or psoriatic arthritis (PsA) [10,11]. In this context, routine biomarkers (C-reactive protein, CRP; erythrocyte sedimentation rate, ESR), rheumatoid factor, anti-cyclic citrullinated peptide antibodies, HLA-B27 expression, imaging features, or the need for upgraded treatment, usually enable accurate diagnosis. For the few CHIK-R patients matching the criteria for IRDs, the differential diagnosis and decision-making for treatment might be even more challenging [12,13,14]
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