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Schilte C, Staikovsky F, Couderc T, Madec Y, Carpentier F, Kassab S, Albert ML, Lecuit M, Michault A. Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis 2013; 7:e2137. [PMID: 23556021 PMCID: PMC3605278 DOI: 10.1371/journal.pntd.0002137] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/11/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Arthritogenic alphaviruses, including Chikungunya virus (CHIKV), are responsible for acute fever and arthralgia, but can also lead to chronic symptoms. In 2006, a Chikungunya outbreak occurred in La Réunion Island, during which we constituted a prospective cohort of viremic patients (n = 180) and defined the clinical and biological features of acute infection. Individuals were followed as part of a longitudinal study to investigate in details the long-term outcome of Chikungunya. METHODOLOGY/PRINCIPAL FINDINGS Patients were submitted to clinical investigations 4, 6, 14 and 36 months after presentation with acute CHIKV infection. At 36 months, 22 patients with arthralgia and 20 patients without arthralgia were randomly selected from the cohort and consented for blood sampling. During the 3 years following acute infection, 60% of patients had experienced symptoms of arthralgia, with most reporting episodic relapse and recovery periods. Long-term arthralgias were typically polyarthralgia (70%), that were usually symmetrical (90%) and highly incapacitating (77%). They were often associated with local swelling (63%), asthenia (77%) or depression (56%). The age over 35 years and the presence of arthralgia 4 months after the disease onset are risk factors of long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases. These data helped define the features of CHIKV-associated chronic arthralgia and permitted an estimation of the economic burden associated with arthralgia. CONCLUSIONS/SIGNIFICANCE This study demonstrates that chronic arthralgia is a frequent complication of acute Chikungunya disease and suggests that it results from a local rather than systemic inflammation.
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Affiliation(s)
- Clémentine Schilte
- Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U818, Paris, France
| | - Frédérik Staikovsky
- Emergency Department, Pôle des Spécialités de l'Urgence, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
| | - Thérèse Couderc
- Biology of Infection Unit, Institut Pasteur, Paris, France
- INSERM U1117, Paris, France
| | - Yoann Madec
- Unité d'Epidémiologie des maladies émergentes, Institut Pasteur, Paris, France
| | - Florence Carpentier
- AgroParisTech, Ecologie Adaptation et Interaction, Paris, France
- INRA, UR1290, Thiverval-Grignon, France
| | - Somar Kassab
- Emergency Department, Pôle des Spécialités de l'Urgence, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
| | - Matthew L. Albert
- Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U818, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Lecuit
- Biology of Infection Unit, Institut Pasteur, Paris, France
- INSERM U1117, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Division of Infectious Diseases, Hôpital Necker Enfants malades, Paris, France
- * E-mail: (ML); (AM)
| | - Alain Michault
- Department of Microbiology, Pôle de biologie, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
- * E-mail: (ML); (AM)
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