Background Chikungunya virus (CHIKV) is a mosquito-borne alphavirus of the family Togaviridae transmitted to humans by the Aedes spp. mosquitoes, causing Chikungunya Fever (CHIKF).
Objectives This study aims to describe the course and outcome of arthritis in patients with CHIKF seen over a 3-month period.
Methods This is a prospective descriptive study. Fifty-one patients with fever, rash, and arthritis seen at the University of the Philippines-Philippine General Hospital and private arthritis clinics were collected from August - December 2012. Demographics and course of arthritis were described.
Results Fifty-one patients, 38 females, 13 male, with a mean age of 38.76 (range 8-61) were diagnosed with CHIKF. All cases were from the Metropolitan Manila area. Of these, 13 had 3-4 family members affected. Twenty-two patients were either employed or were students. The most common presenting symptoms were fever (94.1%), arthritis (88.2%), and rash (88.2%). The most common joint areas involved were the ankles (68.9%), the wrists (42.2%) and the small joints of the hand (53.3%) (especially the first MCP joint), the knees (28.9%), the tarsals (15.6%) and the 1st MTP (11.1%). At week 6, 35 cases were seen; 28 (80%) had persistent arthritis. Eleven (31.4%) patients had arthritis lasting at least 8 weeks. At 12 weeks, 12 patients followed-up; 3 continued to have arthritis. Three cases (5.9%) had myalgia or tenosynovitis of the extensor tendons of the hands. At least half of the cases had to stop work due to arthritis.
Twenty-one patients had (+) CHIKV IgM by ELISA, and 1 had (+) CHIKV PCR. Sixteen of these had chronic arthritis of 6 weeks or longer (range, 6 – 16). Treatment consisted of continuous NSAIDs for at least 2 weeks and some received steroids.
Conclusions This is a report on a recent outbreak of CHIKF, manifesting as a triad of fever, rash, and arthritis, severe enough to cause work stoppage. More females were affected. At least a third had chronic form of rheumatoid arthritis-like polyarthritis. There were families with several members involved. Continuous NSAID coverage was needed and some had to be given steroids.
References Pialoux G, Gaüzère BA, Jauréguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 2007; 7:319-27
Disclosure of Interest None Declared
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