Background This study was performed at a Private hospital in New Delhi, India during the epidemic phase of Viral fever. The peak months of viral fever from mosquitoes (Aedes Aeygpti) like Dengue and Malaria (Anopheles)has been from July to October, till the holy festival of Diwali arrives. Chikungunya came like a wave this time along with dengue and Malaria.The worst epidemic since the last 6 years.A disease common in South India, took North India by a storm. 15–20 deaths were also reported due to Chikungunya virus. Apart from Chikungunya (serology negative) there were a lot of other viruses causing arthritis. Our study deals with post viral arthritis, a new variant which has never been described before.
To study the pattern of arthritis after viral fever. Is it reactive or a new variant
To observe for the evolution of Acute viral arthritis into chronic arthritis
The management of Post viral arthritis
Methods It is a retrospective study conducted at the end of the epidemic. The patients are being followed up over next 3 months to observe for resolution of symptoms, persistent arthritis or evolution into chronic form. 100 patients are being included which were examined and independently assessed by 3 different consultants.
Inclusion criteria: 1. All patients who presented with complaints of persistent joint pains and swelling preceded by fever (Average duration 4–8 weeks). 2. Documented synovitis (Oligoarticular and polyarticular)
Exclusion criteria: 1. Known case of Rheumatoid Arthritis, Connective tissue disease, Vasculitis and Spondyloarthopathy 2. Arthalgia with no documented synovitis 3. Patients on DMARDS previously
Results Detailed results are still under compilation as patients are under follow up (6 months) for further course.
No of patients: 100
Average Age: 47
Average Disease Duration: 6 weeks (after fever)
Average No of Joints involved: 3–4
Symmetry: All Asymmetrical (Large+ Small)
80% patients had asymmetrical joint involvement. Most common joints were: MCP followed by PIP and then the large joints: shoulders and ankles. It was associated with significant early morning stiffness (30 minutes) like other inflammatory arthritis. 60% had response to short course of NSAIDS and low dose steroids (Injection Depomedrol 80 mg intramuscular once a week) and recovered in 2 weeks, 30% had a prolonged course of 4–6 weeks, butdid not need any further medications. 5% developed into Chronic arthritis (Further follow up pending)
Conclusions Reactive arthritis is a known entity and it has typical involvement of the lower limbs, usually preceded by urinary tract infection or GI infection. Even with Viral arthritis, the presentation of joint pains and swelling is usually during the acute fever episode. The pattern described here was different. All the patients had fever at presentation which lasted for 3–5 days and 4–6 weeks later they developed synovitis. There was characteristic involvement of Small joints of the hands (PIP and MCPS) (different from reactive).We are still in process of collecting follow up data which will give us a clue on prognosis of this arthritis and future prospects. So, what do we label it as ... Reactive arthritis-a new variant or a post viral arthritis.
Varache S, Narbonne V, Jousse-Joulin S, et al. Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Results from a nationwide longitudinal prospective cohort study. Arthritis Care Res 2011;63:1565–70.
Disclosure of Interest None declared