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SAT0495 Chikungunya Viral Arthritis in Mexico: Inflammatory Biomarkers, Disability and Disease Activity Index May Be Predictors of Chronic Arthritis
  1. J. Sepúlveda-Delgado1,2,
  2. O.L. Vera-Lastra3,
  3. L.J. Jara4,
  4. K.D.C. Trujillo Murillo5,
  5. R.A. Sanchez Gonzalez5,
  6. A. Lugo Trampe6,
  7. A. Contreras Contreras7,
  8. A. Mendoza Torres7,
  9. J.C. Ramirez Valdespino8,
  10. M. Ocaña Sibilla8
  1. 1Head of Internal Medicine Department, Hospital Regional de Alta Especialidad Ciudad Salud
  2. 2Internal Medicine Department, Instituto Mexicano del Seguro Social, Tapachula
  3. 3Head of Internal Medicine Department, Instituto Mexicano del Seguro Social, UMAE Centro Médico la Raza
  4. 4Education and Research Unit, Instituto Mexicano del Seguro Social, Mexco City
  5. 5Research Unit, Hospital Regional de Alta Especialidad Ciudad Salud
  6. 6Molecular Biology Department, Centro Mesoamericano de Salud Pública y Desastres, Tapachula
  7. 7Internal Medicine Department, Hospital Juarez de México, Mexco City
  8. 8Internal Medicine Department, Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula, Mexico

Abstract

Background Between 2013 to 2014 autochthonous cases ChikV virus were confirmed in the Americas and Mexico. The clinical and inflammatory profile and the prevalence of chronic disease were analyzed in Mexican patients.

Objectives To describe clinical profile, self reported-disability, inflammatory biomarkers and chronic articular (CA) disease during 10 month follow-up in ChikV Mexican patients.

Methods Ten patients with ChikV confirmed by real-time PCR were included. Clinical manifestations, Disease Activity Index (DAS-28), self-reported disability by 32 item WHODAS-2 score and inflammatory biomarkers (C-reactive protein (CRP), eritrosedimentation rate (ESR), Rheumatoid Factor (RF), high sensivity Interleukin-6 (hsIL-6) were measured at onset and every month until 10 months of follow-up.

Results Ten patients (6 women and 4 men) with mean age 48.0 15.04 years-old were followed. Acute symptoms were: fever (100%), arthralgias (100%), myalgias (80%), rash (80%), synovitis (60%), nausea (50%), vomiting (20%) and back pain (20%); number of tender joints was 13.8 (SD 5.09) and number of articulations with synovitis was 7.1 (SD 3.78). At diagnosis biomarkers were: CRP 5.09 (SD 7.23) mg/dl, ESR: 32.6 (SD 17.5) mm/h, rF: 64 (SD 21.7) IU/ml and hsIL-6: 17 (SD 10.3) pg/ml. At diagnosis WHODAS-2 score was 74.5 (SD 7.59) % and DAS-28 was 4.37 (SD 0.78). Four cases resolved in acute phase, 5 developed subacute and CAand 1 patient died (with Systemic Lupus Erythematosus). During follow-up ESR, hsIL-6, DAS-28 index and WHODAS2 score were higher in patients with subacute or CA compared to solved cases (p<0.05). High levels of ESR and hs-IL6 at onset of ChikV infection were related with the development of CA (p<0.05). High DAS 28 index and WHODAS-II score were related to development of subacute or CA (p<0.05).

Conclusions Fever, polyarthralgias, myalgias and rash were the main acute symptoms of ChikV fever and 50% of patients developed CA and a high disability. High levels of hsIL-6 and ESR could be used as a biomarkers to predict CA since acute phase. Inflammatory biomarkers, disability and DAS-28 remained high in subacute an CA compared to solved cases.

  1. Schwartz O, Albert ML. Biology and pathogenesis of Chikungunya virus. Nature Rev Microbiol 2010; 8: 491500.

  2. Leparc-Goffart I, Nougairede A, Cassadou S, et al. Chikungunya in the Americas. Lancet 2014;383:514

  3. Kautz TF, Diaz-Gonzalez EE, Erasmus JH, et al. Chikungunya Virus as cause of Febrile Illness outbreak, Chiapas, Mexico, 2014. Emerg Infect Dis 2015;21(11):2070–2073.

Disclosure of Interest None declared

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