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Lemos JF, Araújo LMC, Guimarães-do-Carmo VJ, Cardoso EJA, da Silva Ferreira AI, Barbosa KFDS, Raposo MCF, Melo RS. Sedentary behavior, increasing age, and overweight/obesity increase the presence and intensity of the chronic joint pain in individuals affected by Chikungunya fever. Clin Rheumatol 2024; 43:2993-3003. [PMID: 39031292 DOI: 10.1007/s10067-024-07073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Chikungunya fever (CF) is a viral disease, transmitted by alphavirus through Aedes aegypti, and albopictus mosquitoes, affecting several people, mainly in tropical countries, when its transmitter is not under control, and the main symptom of the chronic phase of CF is joint pain. OBJECTIVES The primary objective of this study was to observe the prevalence, most affected joints, and intensity of chronic joint pain in individuals affected by CF, and also identify the factors associated with chronic joint pain in these individuals. METHODS Cross-sectional study that evaluated one hundred and thirty volunteers, of both sexes, aged between 20-65 years, with a clinical and/or laboratory diagnosis of CF. The presence of joint pain was investigated using the Brazilian version of the Nordic Questionnaire of Musculoskeletal Symptoms and the intensity of pain using the Visual Analogue Scale. RESULTS Of the 130 volunteers evaluated, n = 112 (86%) reported currently experiencing chronic joint pain, persistent, for approximately 38.6 ± 1.73 months, with the greatest predominance in the morning (58%). The joints most affected by pain were: the ankles (65.5%), interphalangeal joints of the hands (59.2%), and knees (59.2%). The joints that presented the greatest intensity of pain were: the ankles (5.13 ± 0.34), interphalangeal joints of the hands (4.63 ± 0.34), and knees (4.33 ± 0.33). Sedentary behavior (p = 0.037), increasing age (p = 0.000), and overweight/obesity (p = 0.002) were factors associated with chronic joint pain. CONCLUSION A high prevalence of chronic, persistent joint pain was observed, with a greater prevalence in the morning. The joints most affected by chronic pain and with the greatest pain intensity were the ankles, and interphalangeal joints of the hands and knees. Sedentary behavior, increasing age, and overweight/obesity were the factors associated with chronic joint pain in individuals affected by CF in this study. Key Points • Individuals affected by CF had a high prevalence of chronic joint pain, persistent and more prevalent in the mornings • The ankles and interphalangeal joints of the hands and knees were the joints with the highest prevalence of pain • The ankles and interphalangeal joints of the hands and knees were the joints with the greatest pain intensity • Sedentary behavior, increasing age, and overweight/obesity were factors associated with chronic joint pain in individuals affected by CF.
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Affiliation(s)
- Joselanny F Lemos
- Department of Physical Therapy, Faculdade de Integração do Sertão (FIS), Serra Talhada, Pernambuco, Brazil
| | | | | | | | - Ana Isabel da Silva Ferreira
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Av. Jornalista Aníbal Fernandes, 173, Cidade Universitária, Recife, Pernambuco, 50740 - 560, Brazil
| | - Klarice Francisca Dos Santos Barbosa
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Av. Jornalista Aníbal Fernandes, 173, Cidade Universitária, Recife, Pernambuco, 50740 - 560, Brazil
| | | | - Renato S Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Av. Jornalista Aníbal Fernandes, 173, Cidade Universitária, Recife, Pernambuco, 50740 - 560, Brazil.
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Singh G, Trehan S, Goswami K, Kachhadia MP, Puri P. Carpal Tunnel Syndrome as an Atypical Presentation of Chikungunya: A Case Report. Cureus 2024; 16:e65085. [PMID: 39171032 PMCID: PMC11337236 DOI: 10.7759/cureus.65085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
Chikungunya virus (CHIKV) is an arbovirus endemic to tropical and subtropical regions, primarily known for causing fever and severe joint pain. However, its capacity to induce neurological complications is less frequently documented. This case report highlights a rare presentation of carpal tunnel syndrome (CTS) following CHIKV infection, expanding the spectrum of CHIKV manifestations beyond its common arthropathic effects. We detail the case of a 45-year-old male who developed acute CTS symptoms, including pain, numbness, and motor dysfunction in the right thumb, six weeks after experiencing typical CHIKV symptoms of high-grade fever and arthralgia. Despite an initial treatment regimen of corticosteroids aimed at reducing inflammation, the patient's symptoms showed minimal improvement, prompting surgical intervention. Following carpal tunnel release surgery, the patient experienced significant relief and functional recovery. This case underscores the importance of considering CHIKV in the differential diagnosis of CTS in endemic areas, particularly when preceded by typical viral infection symptoms. It also supports surgical intervention as a viable treatment option for CTS associated with CHIKV when conservative management is ineffective, highlighting the need for an interdisciplinary approach in treating atypical manifestations of CHIKV infections.
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Affiliation(s)
- Gurjot Singh
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | - Shubam Trehan
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | - Kanishka Goswami
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | | | - Piyush Puri
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
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Amaral JK, Bingham CO, Taylor PC, Vilá LM, Weinblatt ME, Schoen RT. Therapy for Chikungunya Arthritis: A Study of 133 Brazilian Patients. Am J Trop Med Hyg 2023; 109:542-547. [PMID: 37549898 PMCID: PMC10484246 DOI: 10.4269/ajtmh.23-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
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.
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Affiliation(s)
| | - Clifton O. Bingham
- Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C. Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Luis M. Vilá
- Division of Rheumatology, Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico
| | - Michael E. Weinblatt
- Division of Rheumatology, Inflammation, and Immunity, Harvard Medical School Clinical, Boston, Massachusetts
| | - Robert T. Schoen
- Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut
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Webb E, Michelen M, Rigby I, Dagens A, Dahmash D, Cheng V, Joseph R, Lipworth S, Harriss E, Cai E, Nartowski R, Januraga PP, Gedela K, Sukmaningrum E, Cevik M, Groves H, Hart P, Fletcher T, Blumberg L, Horby PW, Jacob ST, Sigfrid L. An evaluation of global Chikungunya clinical management guidelines: A systematic review. EClinicalMedicine 2022; 54:101672. [PMID: 36193172 PMCID: PMC9526181 DOI: 10.1016/j.eclinm.2022.101672] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally. Methods We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361. Findings 28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1-7)). There were variations in the CMGs' guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use. Interpretation There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care. Funding The UK Foreign, Commonwealth and Development Office, Wellcome Trust [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135].
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Affiliation(s)
- Eika Webb
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Melina Michelen
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ishmeala Rigby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Andrew Dagens
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Dania Dahmash
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Vincent Cheng
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Samuel Lipworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Erhui Cai
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Robert Nartowski
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | | | | | - Evi Sukmaningrum
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- HIV AIDS Research Centre-HPSI, AJCU, Jakarta, Indonesia
| | - Muge Cevik
- Department of Global Health and Infection Research, School of Medicine, University of St Andrews, Fife, Scotland, UK
| | | | | | - Tom Fletcher
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Lucille Blumberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Peter W. Horby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Shevin T. Jacob
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Louise Sigfrid
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
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Viral Arthritis. Clin Rheumatol 2021. [DOI: 10.1007/978-981-33-4885-1_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brito CAAD, Freitas ARR, Said RF, Falcão MB, Cunha RVD, Siqueira AM, Teixeira MG, Ribeiro GS, Brito MCMD, Cavalcanti LPDG. Classification of chikungunya cases: a proposal. Rev Soc Bras Med Trop 2020; 53:e20200529. [PMID: 33263689 PMCID: PMC7723373 DOI: 10.1590/0037-8682-0529-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Carlos Alexandre Antunes de Brito
- Universidade Federal de Pernambuco, Departamento de Medicina Clínica, Recife, PE, Brasil.,Instituto de Pesquisa Autoimune, Recife, PE, Brasil.,Ministério da Saúde do Brasil, Comitê Técnico de Arboviroses, Brasília, DF, Brasil
| | | | | | - Melissa Barreto Falcão
- Universidade Estadual de Feira de Santana, Núcleo de Pesquisa e Extensão em Vigilância à Saúde, Feira de Santana, BA, Brasil
| | - Rivaldo Venâncio da Cunha
- Fundação Oswaldo Cruz, Campo Grande, MS, Brasil.,Universidade Federal do Mato Grosso do Sul, Escola de Medicina, Campo Grande, MS, Brasil
| | - André Machado Siqueira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | | | - Guilherme Sousa Ribeiro
- Universidade Federal da Bahia, Escola de Medicina, Salvador, BA, Brasil.,Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil
| | - Marina Coelho Moraes de Brito
- Instituto de Pesquisa Autoimune, Recife, PE, Brasil.,Universidade Federal de Pernambuco, Centro de Ciências Médicas, Recife, PE, Brasil
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