Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil

Monaíse M.O Silva,Mariana Kikuti,Rosângela O Anjos,Moyra M Portilho,Viviane C Santos,Thaiza S.F Gonçalves,Laura B Tauro,Patrícia S.S Moreira,Leile C Jacob-Nascimento,Perla M Santana,Gúbio S Campos,André M Siqueira,Uriel Kitron,Mitermayer G Reis,Guilherme S Ribeiro

doi:10.1016/j.ijid.2021.03.003

Abstract

ObjectivesTo investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. MethodsFrom September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. ResultsOf 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95–2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01–1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48–1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). ConclusionsThese findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.

Highlights

The most prominent clinical manifestations of acute chikungunya virus (CHIKV) infection are joint pain and fever (Weaver and Lecuit, 2015)
Of 948 patients with acute febrile illness enrolled in the surveillance study, 265 (28.0%) had laboratory evidence of CHIKV infection (Figure 1)
Except for the period between December 2014 and February 2015, CHIKV infection cases were detected throughout the study period, but they peaked between July and November 2015 (Figure 2)

Summary

Introduction

The most prominent clinical manifestations of acute chikungunya virus (CHIKV) infection are joint pain and fever (Weaver and Lecuit, 2015). Chronic arthralgia is usually associated with significant disability which limits everyday activities and leads to physical and mental suffering, reported by patients as lack of appetite, nonrestorative sleep, mood swings and depression (Elsinga et al, 2017; Couzigou et al, 2018). Such symptoms can result in absence from work or school, which may result in loss of employment or withdrawal from school, and reduced quality of life (Marimoutou et al, 2012; Bastos et al, 2018; Couzigou et al, 2018; Hossain et al, 2018). It has been estimated that approximately 400,000 individuals developed post-chikungunya chronic inflammatory rheumatism following the epidemics of 2014 (RodriguezMorales et al, 2015), with between 151,000 and 167,000 disabilityadjusted life-years lost in the region (Cardona-Ospina et al, 2015b)

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