Inflammatory Musculoskeletal Disease Research Articles

The impact of the COVID-19 pandemic on referrals to musculoskeletal services from primary care and subsequent incidence of inflammatory rheumatic musculoskeletal disease: an observational study.

The aim was to describe the impact of the COVID-19 pandemic upon referral patterns and incident diagnosis of inflammatory rheumatic and musculoskeletal diseases (iRMDs). UK primary care data were used to describe referral patterns for patients with musculoskeletal conditions. Trends in referrals to musculoskeletal services and incident diagnoses of iRMDs (specifically, RA and JIA) were described using Joinpoint Regression and comparisons made between key pandemic time periods. The incidence of RA and JIA reduced by -13.3 and -17.4% per month, respectively, between January 2020 and April 2020, then increased by 1.9 and 3.7% per month, respectively, between April 2020 and October 2021. The incidence of all diagnosed iRMDs was stable until October 2021. Referrals decreased between February 2020 and May 2020 by -16.8% per month from 4.8 to 2.4% in patients presenting with a musculoskeletal condition. After May 2020, referrals increased significantly (16.8% per month) to 4.5% in July 2020. The time from first musculoskeletal consultation to RA diagnosis and from referral to RA diagnosis increased in the early pandemic period [rate ratio (RR) 1.11, 95% CI 1.07, 1.15 and RR 1.23, 95% CI 1.17, 1.30, respectively] and remained consistently higher in the late pandemic period (RR 1.13, 95% CI 1.11, 1.16 and RR 1.27, 95% CI 1.23, 1.32, respectively), compared with the pre-COVID-19 pandemic period. Patients with underlying RA and JIA that developed during the pandemic might be yet to present or might be in the referral and/or diagnostic process. Clinicians should remain alert to this possibility, and commissioners should be aware of these findings, enabling the appropriate planning and commissioning of services.

The Biology of Pain: Through the Rheumatology Lens.

Chronic pain is a major socioeconomic burden globally. The most frequent origin of chronic pain is musculoskeletal. In inflammatory musculoskeletal diseases such as rheumatoid arthritis (RA), chronic pain is a primary determinant of deleterious quality of life. The pivotal role of peripheral inflammation in the initiation and perpetuation of nociceptive pain is well-established among patients with musculoskeletal diseases. However, the persistence of pain, even after the apparent resolution of peripheral inflammation, alludes to the coexistence of different pain states. Recent advances in neurobiology have highlighted the importance of nociplastic pain mechanisms. In this review we aimed to explore the biology of pain with a particular focus on nociplastic pain in RA.

Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center

Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is aclinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria. To investigate the prevalence and severity of SP in patients with RMD. A total of 141consecutive patients over 65years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in across-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP1 and2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as aparameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in astandardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student'sT-test and the χ2-test were used for statistics. Of the patients included 73% were female, the mean age was73 years and 80% had an inflammatory RMD. According to EWGSOP2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP. This study showed arelatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in astandardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.

Anti-Inflammatory Drugs and Immunosuppressants in Rheumatological and Musculoskeletal Diseases

Objective: To determine drug compliance among patients with rheumatological and musculoskeletal diseases and to identify the reasons behind poor compliance.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Rheumatology Lady Reading Hospital, Peshawar Pakistan, from Aug 2020 to Feb 2021.
 Methodology: All patients aged 16 to 70, of either gender with inflammatory rheumatic diseases who were prescribed conventional DMARDs for at least six months were included in the study.
 Results: Two hundred and eighteen patients were included in the study. There were 59(27.1%) males and 159(72.9%) females with a mean age of 38.56±4.75years. There were 156 SPRA patients (71.5%), while SLE and SNIA accounted for 22(10.1%) and 17(7.8%) cases, respectively. Methotrexate was the most commonly prescribed medicine, 158(72.5%) while 90(41.3%) patients were prescribed Hydroxychloroquine and 43(19.7%) patients were prescribed Sulfasalazine. Regarding compliance, 112 (51.4%) patients were found to have good drug adherence. On the other hand, side effects and lack of awareness were found to be the most common cause of poor medication adherence.
 Conclusion: We concluded that adherence to medication among patients with inflammatory rheumatic and musculoskeletal diseases is poor

Endothelial dysfunction in axial spondyloarthritis associated with inflammatory bowel disease

Spondyloarthritis is a group of musculoskeletal inflammatory diseases, including axial and peripheral forms. The current classification of these diseases emphasizes the diagnostic importance of the well-known association between spondyloarthritis and inflammatory bowel diseases (Crohns disease and ulcerative colitis). According to many large clinical studies, both spondyloarthritis and inflammatory bowel diseases demonstrate increased cardiovascular risk, but the underlying mechanisms are not entirely clear. One of the possible ways to involve the cardiovascular system in these diseases is supposed to be the formation of endothelial vascular dysfunction developing in many inflammatory and non-inflammatory conditions. At the same time, endothelial dysfunction needs to be analyzed multidimensionally due to its participation in regulation of many processes, such as the providing of vascular tone, cell migration, angiogenesis, and hemostasis.
 This review examines the latest data on endothelial dysfunction in axial spondyloarthritis and inflammatory bowel diseases, and separately analyzes the studies of this phenomenon in patients with inflammatory bowel diseases-associated axial spondyloarthritis. Special attention is paid to modern laboratory and instrumental methods for assessing endothelial function and their potential diagnostic significance in clinical practice.

COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection

ObjectiveCOVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19. MethodsWe conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group). ResultsData were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]). ConclusionRMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups.

No Relationship Between Blood Groups and Psoriatic arthritis

Background: Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease. The exact causes of PsA have not been identified. ABO and Rh blood groups continue to be an area of interest for various diseases. In this study, we aimed to evaluate whether there is any difference in the distribution of ABO and Rh blood groups in PsA.
 Methods: 233 PsA patients (PsA group) consecutively referred to the adult rheumatology outpatient clinics of a tertiary care hospital of central Anatolia between January 2019 and June 2020 were enrolled. The blood groups of the PsA group were compared with the blood groups of 6280 individuals who tested before elective operations at the same hospital between 1 January 2019 and 31 June 2020 (Control Group). Fourteen of the control group were excluded due to the presence of psoriasis/PsA in their medical records. In addition, the blood groups of 38,416 people who voluntarily donated blood to the Turkish Red Crescent XXXX Blood Center between January 1, 2019 and July 1, 2020 (donor group) were compared with the blood groups of the control group.
 Results: There was no significant difference between the PsA patients and the control group in any blood group, both in women, men and also cumulatively. 
 Conclusion: The result of the study shows there is no significant difference in the blood groups between patients with PsA and the control group.

High Prevalence of Foot Insufficiency Fractures in Patients With Inflammatory Rheumatic Musculoskeletal Diseases.

To assess the prevalence of foot insufficiency fractures (IF) in patients with rheumatic musculoskeletal disease (RMD) with foot pain. In a retrospective design, 1752 magnetic resonance imaging (MRI) scans of consecutive patients presenting with foot pain in 2 time periods between 2016 and 2018 were evaluated. The group with IF was matched with controls with foot pain without IF. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Multivariate analyses were performed. A total of 1145 MRI scans of patients (median age 59 yrs, 82.9% female) with an inflammatory (65.4%) and of 607 with no inflammatory (34.6%) RMD (median age 58 yrs, 80.8% female) were available. Most patients had rheumatoid arthritis (RA; 42.2%), and others had psoriatic arthritis (22.4%), axial spondyloarthritis (11.1%), or connective tissue disease (CTD; 7.6%). Foot IF were found in 129 MRI scans of patients (7.5%). There was no difference between time periods. The prevalence of IF was highest in CTD (23%) and RA (11.4%). More patients with an inflammatory than a noninflammatory RMD had IF (9.1% vs 4.1%, respectively; P < 0.001). Using conventional radiography, IF were only detected in 25%. Low BMD and a history of fractures were more frequent in patients with IF than without (42.6% vs 16.2% and 34.9% vs 8.6%, respectively; P < 0.001). A high prevalence of foot fractures was found in MRI scans of patients with RMD, many without osteoporosis. MRI was more sensitive than radiographs to detect IF.

Progranulin in Musculoskeletal Inflammatory and Degenerative Disorders, Focus on Rheumatoid Arthritis, Lupus and Intervertebral Disc Disease: A Systematic Review.

Progranulin (PGRN) is a glycoprotein formed by 593 amino acids encoded by the GRN gene. It has an important role in immunity and inflammatory response, as well as in tissue recovery. Its role in musculoskeletal inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and intervertebral disc degeneration disease (IVDD), is, nowadays, an important target to investigate. The objective of this review is to systematically sum up all the recent findings concerning PGRN as a target in the development and resolution of the inflammatory diseases. PubMed was examined with the terms combinations (Progranulin) AND (Lupus Erythematosus, Systemic), (Progranulin) AND (Arthritis, Rheumatoid), and (Progranulin) AND (Intervertebral Disc Degeneration). PubMed was examined with the terms combinations (Atsttrin) AND (Lupus Erythematosus, Systemic), (Atsttrin) AND (Arthritis, Rheumatoid), and (Atsttrin) AND (Intervertebral Disc Degeneration). Moreover, research through Web of Science was performed searching the same items. The inclusion criteria were: studies whose main topic were progranulin, or atsttrin, with emphasis on the three selected diseases. On the other hand, the exclusion criteria were studies that only focused on diseases not related to RA, lupus or IVDD, in addition to the previous published literature reviews. Since few results were obtained, we did not filter by year. The records assessed for eligibility were 23, including all the studies with the information in state of art of progranulin and its capability to be a potential target or treatment for each one of the selected diseases. As these results are descriptive and not clinical trials, we did not perform risk of bias methods. Within these results, many studies have shown an anti-inflammatory activity of PGRN in RA. PGRN levels in serum and synovial fluids in RA patients were reported higher than controls. On the other hand, serum levels were directly correlated with SLE disease activity index, suggesting an important role of PGRN as a player in the progression of inflammatory diseases and a therapeutical approach for the recovery. This review has some limitations due to the small number of studies in this regard; therefore, we highlight the importance and the necessity of further investigation. No external funding was implicated in this systematical review.

Comparative efficacy and safety of JAK inhibitors and leflunomide in rheumatoid arthritis: A protocol for systematic review and meta-analysis.

Rheumatoid arthritis is the most prevalent systemic autoimmune disease among the rheumatic inflammatory musculoskeletal diseases. Currently, there is no reliable evidence regarding the comparisons of anti-rheumatic effects between leflunomide and Janus kinase inhibitors. We performed a protocol for systematic review and meta-analysis to compare the efficacy and safety of Janus kinase inhibitors and leflunomide in rheumatoid arthritis. This review has been reported following the preferred reporting items for systematic reviews and meta-analyses protocol. We will search 7 electronic databases to identify relevant studies from inception to November, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. Risk of bias will be assessed according to the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development and Evaluation system will be used to judge the overall quality of evidence supporting outcomes in this work. Data analysis was performed using Reviewer Manager 5.4. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide evidence to judge whether Janus kinase inhibitors is superior to leflunomide in patients with in rheumatoid arthritis.

Monitoring chronic inflammatory musculoskeletal diseases mixing virtual and face-to-face assessments-Results of the digireuma study.

Mobile health technology holds great promise for the clinical management of patients with chronic disease. However, evidence on the implementation of projects involving digital health solutions in rheumatology is scarce. We aimed to study the feasibility of a hybrid (virtual and face-to-face) monitoring strategy for personalized care in rheumatoid arthritis (RA) and spondyloarthritis (SpA). This project included the development of a remote monitoring model and its assessment. After a focus group with patients and rheumatologists, relevant concerns regarding the management of RA and SpA were raised, leading to the development of the Mixed Attention Model (MAM), which combined hybrid (virtual and face-to-face) monitoring. Then, a prospective study using the mobile solution Adhera for Rheumatology was conducted. Over a 3-month follow-up period, patients were given the opportunity to complete disease-specific electronic patient reported outcomes (ePROs) for RA and SpA with a pre-established frequency, as well as flares and changes in medication at any time. Number of interactions and alerts were assessed. The usability of the mobile solution was measured by the Net-Promoter Score (NPS) and through a 5-star Likert scale. Following the MAM development, forty-six patients were recruited to utilize the mobile solution, of whom 22 had RA and 24 SpA. There were 4,019 total interactions in the RA group, and 3,160 in the SpA group. Fifteen patients generated a total of 26 alerts, of which 24 were flares and 2 were medication-related problems; most (69%) were managed remotely. Regarding patient satisfaction, 65% of the respondents were considered to have endorsed Adhera for Rheumatology, yielding a NPS of 57 and an overall rating was 4.3 out of 5 stars. We concluded that the use of the digital health solution is feasible in clinical practice to monitor ePROs for RA and SpA. Next steps involve the implementation of this telemonitoring method in a multicentric setting.

Are we approaching a holistic view of leptin's role in arthritis?

Adipokines—in particular, leptin, the forerunner of this superfamily—are receiving increasing attention for their role in exerting both beneficial and harmful actions in musculoskeletal inflammatory diseases. Leptin has been extensively associated with cartilage metabolism and OA. OA human chondrocytes have been shown to produce higher levels of leptin than normal cartilage1, with the pattern of leptin expression related to the level of cartilage destruction2,3. Moreover, elevated leptin levels have been found in serum, IPFP, synovial tissues, and cartilage of OA patients compared with healthy controls4,5.

Ayurvedic Management of Psoriatic Arthritis- A Case Study

Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with both autoimmune and autoinflammatory features characteristically occurring in individuals with psoriasis. The prevalence of PsA in the Indian population was reported in 8.47% cases of Psoriasis. The symptoms such as skin manifestations and pain in the small joints presented in PsA very much resemble to Gambhira Vatarakta mentioned in Ayurveda classics. Even though, the main culprit involved in Vatarakta is Vata and rakta. Also, dhatus like rasa, mamsa, asthi, and majja are involved in the pathogenesis. The treatment principle focuses on controlling inflammation and affected joints to prevent joint pain and further disability. A 46-year-old male patient visited IPD of Kayachikitsa with complaints of pain and swelling in small joints along with presenting with flaky scales and itching over the scalp region, low back, and both lower limbs. The management was done on the basis of following treatment modalities: - Ama pacana, rakta prasadanam, sodhananga snehapanam, virechana, and Rasayana. The assessment was done before and after the treatment by using the PASI score and EULAR criteria. It was observed there was a relief for symptoms and changes in biochemical parameters. To stabilize the positive response of this treatment, Samana chikitsa and Rasayana were advised as a follow-up for a period of one month.

Intraovarian Injection of Reconstituted Lyophilized Growth-Promoting Factor Extracted from Horse Blood Platelets (L-GFequina) Increases Oocytes Recovery and In Vitro Embryo Production in Holstein Cows.

Simple SummaryLyophilized horse-platelet-derived growth factor (L-GFequina) is a brand-new, improved platelet-rich protein growth factor. It has been successfully used to treat a number of inflammatory and degenerative musculoskeletal diseases in several disciplines of regenerative medicine. Our study aimed to evaluate the possibility of using an intraovarian injection of L-GFequina in the assisted reproduction of Holstein cows. L-GFequina employs allogenic, pathogen-free platelets from horses that have been successfully used in other species to prevent changes in technical platelet specifications caused by the centrifugation process and time, as well as the integrity and quality of autologous platelets. The number of ovum pick-up (OPU) sessions per cycle, the growth of medium- and large-sized follicles, the number of COCs produced per cow per session, and the formation of blastocysts during OPU-IVEP in eCG stimulated Holstein cows were all boosted in this study by an intraovarian injection of L-GFequina.The purpose of this study was to determine the impact of intraovarian injections of a reconstituted lyophilized growth-promoting factor extracted from horse blood platelets (L-GFequina) on the number of ovarian follicles, the recovery of cumulus–oocyte complexes (COCs), and embryo development to the blastocyst stage in Holstein cows. Thus, 12 Holstein cows were assigned to three protocols. According to the number of punctured follicles in protocol 1, ovum pick-up (OPU) was conducted on days 6 and 14 of the cycle (day 0 = estrus). In protocol 2, every large follicle (more than 7 mm) was removed, and 1 mL of L-GFequina was intraovarian injected (day 0). Two days later, equine chorionic gonadotropin (eCG) was administered, and OPU sessions were conducted on days 6, 10, and 14. The same ovarian stimulation procedure as that in protocol 2 was performed in protocol 3, except that equine L-GFequina was not supplied. OPU was carried out on days 6 and 10 of the cycle. The results indicate that the intraovarian injection of L-GFequina significantly (p < 0.05) increased the number of OPU sessions per cycle, the recovery of cumulus–oocyte complexes (COCs), and the production of blastocysts. In conclusion, an intraovarian injection of L-GFequina can improves OPU-IVEP results in Holstein cows.

P61 SARS-CoV-2 vaccine safety in adolescents with inflammatory rheumatic and musculoskeletal diseases and adults with juvenile idiopathic arthritis: data from the EULAR COVAX physician-reported registry

Introduction/BackgroundThere is a lack of data on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination safety in children and young people (CYP) with rheumatic and musculoskeletal diseases (RMDs) as they were excluded from initial vaccine trials. Vaccination guidance is based on data from adults with or CYP without RMDs.Description/MethodOur objective was to describe the safety of SARS-COV-2 vaccination in adolescents with inflammatory RMDs and adults with JIA. We described patient characteristics, flares, and adverse events in adolescent cases under 18 with inflammatory RMDs and adult cases aged 18 or above with JIA submitted to the European Alliance of Associations for Rheumatology (EULAR) COVAX registry.Discussion/ResultsThirty-six adolescent cases were reported from 4 countries, mostly female (58%) with JIA (42%: 28% non-systemic JIA, 14% systemic JIA) and a median age of 15 [IQR: 14.5, 17]. Most were in remission (64%) or had minimal (22%) disease activity at the time of vaccination. Over half of the adolescent group (56%) reported early reactogenic-like AEs. One mild polyarthralgia flare and one serious AE of special interest (malaise) were reported. No CYP reported SARS-CoV-2 infection post-vaccination. No cases of paediatric inflammatory multi-system syndrome or myocarditis adverse events were reported.Seventy-four adult JIA cases were reported from 11 countries; 73% were female with a median age of 26 [IQR: 23, 31]. Eight-five percent had ns-JIA and 15% had s-JIA. Almost two thirds (62%) reported early reactogenic-like AEs and two flares were reported (mild polyarthralgia and moderate uveitis). No serious AEs of special interest were reported among adults with JIA. Three 20-30 year old females were diagnosed with SARS-CoV-2 post-vaccination; all fully recovered.Key learning points/ConclusionIn this observational registry dataset, SARS-CoV-2 vaccines appeared safe in adolescents with RMDs and adults with JIA, with a low frequency of disease flares, serious AEs, and SARS-CoV-2 re-infection seen in both populations.

Outcome of COVID-19 in patients with rheumatic and inflammatory diseases treated with mycophenolic acid: data from the French RMD COVID-19 cohort

BackgroundPatients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving mycophenolic acid (MPA) may have a less favourable outcome from COVID-19 infection. Our aim was to investigate whether MPA treatment is...

Sex- and gender-related differences in psoriatic arthritis.

Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with a chronic, progressive course. Various aspects of PsA, including its clinical features, disease course and response to treatment, are influenced by sociodemographic characteristics of the patient. This includes patient sex, the biological attributes associated with being male or female, and gender, a sociocultural construct that comprises attitudes, traits and behaviours associated with being a man or a woman. An understanding of sex- and gender-related differences in PsA, as well as their underlying mechanisms, is therefore important for individualized care. In this narrative review, the influence of sex and gender on PsA manifestation and course, patient function and quality of life, and their association with comorbidities are described. Sex- and gender-related disparities in response to advanced therapies and their potential underlying mechanisms are delineated. Differences in pathophysiological mechanisms between male and female patients including genetics, immune and hormonal mechanisms are discussed. Finally, fertility and pregnancy outcomes in PsA are outlined. By adopting sex and gender lenses, this review is aimed at highlighting key differences between male and female patients with PsA and uncovering mechanisms underlying these differences, ultimately promoting individualized care of men and women with PsA and informing future research in this area.

SARS-CoV-2 vaccine safety in adolescents with inflammatory rheumatic and musculoskeletal diseases and adults with juvenile idiopathic arthritis: data from the EULAR COVAX physician-reported registry

BackgroundThere is a lack of data on SARS-CoV-2 vaccination safety in children and young people (CYP) with rheumatic and musculoskeletal diseases (RMDs). Current vaccination guidance is based on data from...

Racial and ethnic differences in COVID-19 outcomes: a call to action.

Racial and ethnic differences in COVID-19 outcomes: a call to action.

An Overview of Chikungunya Virus Molecular biology, epidemiology, pathogenesis, Treatment and Prevention Strategies

The chikungunya virus (CHIKV) causes a devastating musculoskeletal inflammatory disease with symptoms of headache, rash, polyarthralgia, fever and myalgia. CHIKV has appeared intermittently around the world and in different ecological zones of Pakistan. Aedes mosquito species are the main vectors of CHIKV transmission and cause high disease rates in the urban transmission cycle. Even though the CHIKV is responsible for many cases of disease, no authorized antibodies or antiviral treatments are available, and prevention is the primary countermeasure. This review describes an update on CHIKV molecular biology, replication cycle, epidemiology, ecological factors, clinical manifestations and treatment and suggests a way forward to control and prevent this infection strategically in the future.