Therapy for Chikungunya Arthritis: A Study of 133 Brazilian Patients

José Kennedy Amaral Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Brazil;

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Clifton O. Bingham III Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland;

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Peter C. Taylor Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom;

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Luis M. Vilá Division of Rheumatology, Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico;

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Michael E. Weinblatt Division of Rheumatology, Inflammation, and Immunity, Harvard Medical School Clinical, Boston, Massachusetts;

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Robert T. Schoen Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut

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ABSTRACT.

Chikungunya fever is a global vector-borne viral disease. Patients with acute chikungunya are usually treated symptomatically. The arthritic phase may be self-limiting. However, many patients develop extremely disabling arthritis that does not improve after months. The aim of this study was to describe the treatment of chikungunya arthritis (CHIKA) patients. A medical records review was conducted in 133 CHIKA patients seen at a rheumatology practice. Patients were diagnosed by clinical criteria and confirmed by the presence of anti-chikungunya IgM. Patients were treated with methotrexate (20 mg/week) and/or leflunomide (20 mg/day) and dexamethasone (0–4 mg/day) for 4 weeks. At baseline visit and 4 weeks after treatment, Disease Activity Score 28 (DAS28) and pain (using a visual analog scale) were ascertained. Five months after the end of treatment, patients were contacted to assess pain, tender joint count, and swollen joint count. The mean age of patients was 58.6 ± 13.7 years, and 119 (85%) were female. After 4 weeks of treatment, mean (SD) DAS28-erythrocyte sedimentation rate (6.0 [1.2] versus 2.7 [1.0], P < 0.001) and pain (81.8 [19.2] to 13.3 [22.9], P < 0.001) scores significantly decreased. A total of 123 patients were contacted 5 months after the end of treatment. Pain score, tender joint count, and swollen joint count significantly declined after 4 weeks of treatment, and the response was sustained for 5 months. In this group of patients with CHIKA, 4-week treatment induced a rapid clinical improvement that was maintained 5 months after the end of therapy; however, the contribution of treatment to these outcomes is uncertain.

Author Notes

Address correspondence to J. Kennedy Amaral, Institute of Diagnostic Medicine of Cariri, Ave. Leão Sampaio, 1401, Juazeiro do Norte, Ceará 63040-000, Brazil. E-mail: kennedyamaral@ufmg.br

Authors’ addresses: J. Kennedy Amaral, Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Brazil, E-mail: kennedyamaral@ufmg.br. Clifton O. Bingham III, Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: cbingha2@jhmi.edu. Peter C. Taylor, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, E-mail: peter.taylor@kennedy.ox.ac.uk. Luis M. Vilá, Division of Rheumatology, Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico, E-mail: luis.vila2@upr.edu. Michael E. Weinblatt, Division of Rheumatology, Inflammation, and Immunity, Harvard Medical School, Boston, MA, E-mail: mweinblatt@bwh.harvard.edu. Robert T. Schoen, Section of Rheumatology, Yale University School of Medicine, New Haven, CT, E-mail: robert.schoen@yale.edu.

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