Rheumatic problems plague chikungunya patients




Approximately one-third of chikungunya patients who acquired the disease during Caribbean travel reported postchikungunya muscle pain, joint pain, and joint swelling, according to data for 28 patients seen at a single center in 2014. The findings were published in Travel Medicine and Infectious Disease (2016. doi: 10.1016/j.tmaid.2016.01.009).

The researchers contacted 19 of the patients approximately 13 months after their original diagnoses. Of these, 37% described ongoing rheumatic problems; 32% reported joint pain, 32% reported joint swelling, and 26% reported muscle pain.

CDC/Cynthia Goldsmith

Dr. Cosmina Zeana of Bronx-Lebanon Hospital Center, New York, and colleagues initially identified 28 adult patients with a median age of 52 years. Most were Hispanic (96%) and half were women (54%). The average length of stay in the Caribbean was 30 days, and 82% had visited the Dominican Republic. The follow-up data were collected via a telephone questionnaire.

Chikungunya has become endemic in Latin America, the researchers noted. “Of increasing concern is the occurrence of persistent rheumatic and general disabling symptoms that can last for several years following acute infection,” they wrote. Transmission of chikungunya has been documented throughout the Caribbean, but this study is the first known assessment of postchikungunya rheumatologic disorders among individuals diagnosed with acute chikungunya after traveling to the Caribbean in particular, they added.

At follow-up, three patients without preexisting rheumatic disease met criteria for diffuse postchikungunya (pCHIK) musculoskeletal disorders. In addition, four patients with preexisting rheumatic disease reported an increase in symptom severity including worsening knee osteoarthritis in both knees (one patient) and increased joint involvement (three patients).

Significantly more patients with preexisting disease reported using pain medication, compared with those without preexisting disease. However, no significant differences appeared in the percentage of patients in each group reporting other symptoms including joint pain, muscle pain, and joint swelling.

Nearly all the patients presented for acute care with fever (99%), joint pain (89%), myalgia (70%), and joint swelling (68%). The median pain level was 8 on a scale of 1-10.

Other symptoms reported at the time of acute diagnosis included gastrointestinal problems (59%), headache (48%), and rash (48%). Almost half the patients (46%) required inpatient care, with complications including hypotensive episodes, syncope, electrolyte imbalance, and thrombocytopenia.

“Patients seeking pretravel health care in preparation for a trip to the Caribbean – as to any other CHIK-endemic 185 region – need to be comprehensively counseled about the health risks related to the acute stage of the infection as well as related to the risk for developing a potentially long-lasting rheumatic disorder,” the researchers said.

“An integrated care plan for patients with acute CHIK consisting of follow-up appointments with the primary care provider and a rheumatologist with the aim of reducing the time to identify patients with pCHIK rheumatic disorders and initiation of optimal disease management may be useful and need further study,” they added.

The findings were limited by several factors including small sample size, use of self-reports, and narrow geographic range. The researchers had no financial conflicts to disclose.

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