Clinical Manifestations and Outcomes in Disease-Modifying Antirheumatic Drug-Naive Adult Patients with Chronic Chikungunya Arthritis

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  • 1 Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;
  • 2 Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;
  • 3 Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico

Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case–control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with low disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-severe disease activity and had substantial functional disability. Diabetes mellitus, chronic low back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.

Author Notes

Address correspondence to Luis M. Vilá, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan PR 00936-5067, Puerto Rico. E-mail: luis.vila2@upr.edu

Financial support: This work was supported by the National Institute of General Medical Sciences (NIGMS) grant number U54GM133807 for the Hispanic Alliance for Clinical and Translational Research and the National Institute of Minority Health and Health Disparities grant number G12MD007600 for the Research Centers for Minority Institutions (RCMI) Program.

Authors’ addresses: Nicolle Medina-Cintrón, Yaritza Berríos-López, and Luis M. Vilá, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, E-mails: nicolle.medina@upr.edu, yaritza.berrios@upr.edu, and luis.vila2@upr.edu. Idali Martínez, Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, E-mail: idali.martinez@upr.edu. Naydi Pérez-Ríos, Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, E-mail: naydi.perez@upr.edu.

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