Post Chikungunya Arthritis: A Real Diagnostic and Therapeutic Challenge

Abstract

Objective: To evaluate the response of disease modifying anti rheumatic drugs (DMARDs) on patients diagnosed with post chikungunya inflammatory arthritis attending outpatient department of Rheumatology, Jinnah Medical College Hospital, Karachi, Pakistan.

Methods: This prospective case series study was conducted at Rheumatology clinic of Jinnah Medical College Hospital in Karachi, Pakistan from January – June 2017 after a serious Chikungunya outbreak in November 2016. All patients diagnosed with Chikungunya viral fever who had joint pain refractory to non-steroidal anti-inflammatory drugs (NSAIDs) were evaluated. All eligible patients were given a trial of DMARDs along with systemic steroids (tapering) for 6 months. Clinical response and inflammatory burden were evaluated using the Disease Activity Score (DAS 28).

Results: Of 112 patients, more than half the population, 65/112 (58%) was in acute flare of disease at the beginning of study and interestingly not a single patient had high disease activity (DAS >5.1) at the end of 6 months. Patients who went into disease remission were able to lead a pain free life, while those with a relatively higher DAS28 were still struggling with the disease. The overall response to the therapy was eloquent. None of the patient remained in active flair by the end of 6 months. The mean DAS significantly decline at 6 months as compared to the baseline DAS (2.79 ±0.89 vs. 4.96 ±1.11 respectively, p-value <0.001)

Conclusion: Chikungunya virus can lead to symmetrical inflammatory arthritis that phenotypically mimics Rheumatoid arthritis but is not primarily Rheumatoid arthritis.