Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia

Abstract

Introduction

Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America.

Methods

Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59–68 weeks (1.13–1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema).

Results

Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47–9.53). The 29.2% of patients required medical attention because of symptoms.

Conclusions

Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.

Introduction

Chikungunya virus disease (CHIKV) has expanded in Latin America since 2013, with a clear increase in the epidemiological and disability burden, by high morbidity attributed to its acute phase, as well as by persistence of symptoms in its chronic phase and consequences [1], [2]. There is an association between CHIKV and subsequent development of unspecified arthritis or rheumatoid arthritis, seronegative spondylitis and other non-inflammatory musculoskeletal manifestations such as persistent arthralgia [3], [4]. Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is defined as arthritis, musculoskeletal pain or unspecified arthralgia, which persists for more than 3 months after acute infection, without previous history of rheumatic disease or musculoskeletal discomfort [5], [6].

Previous studies, estimate about 47.57% (95%CI 45.08–50.13) of infected patients in endemic areas would develop pCHIK-CIR, with a median follow-up of 20.12 months, during a maximum time of 72 months (6 years); and these sequelae have been reported in tropical and subtropical areas, and also in European countries among imported cases [7], [8]. The most recent systematic review and meta-analysis about prevalence of pCHIK-CIR in the literature, describes that in the most conservative scenario, about 25% of CHIK cases could develop this rheumatologic sequel and 14% chronic arthritis [6].

However, those estimates were obtained from studies carried out in France and India [8] and may not be extrapolated to Latin American countries, because of environmental variations by geographical area, genetic and immunological profile of the hosts and variation of the viral characteristics [9]. Therefore, three cohorts have been published in Colombia and Latin America, reporting a significant proportion of cases that progress to pCHIK-CIR, especially polyarthralgia [9], [10], [11], [12]. One of these investigations was carried out during 2015 in the municipality of Venadillo in the department of Tolima [11], which is part of the Colombian endemic areas for dengue virus (DENV) and CHIKV, and they share the same vector, Aedes aegypti and A. albopictus [12]. The initial study in Tolima [11] evidenced that about half of the patients persisted with post-CHIK arthralgia after 24 weeks of follow-up [11], which is higher than the results reported in other countries [13]. All these findings represent a great challenge for infectious diseases, rheumatology and travel medicine practitioners, but still many aspects need to be clarified [14], [15], [16], [17], [18], [19], [20].

After one year the initial diagnosis of patients observed in Venadillo, Tolima, Colombia, a new assessment, with the objective to determine the prevalence of chronic rheumatic sequelae attributable to CHIKV, was necessary and done. This, to providing information regard the progression, knowledge and some risk factors, about pCHIK-CIR as a growing consequence of CHIK in Colombia and Latin America. Furthermore, continuing searching for related factors and relevant information in predicting consequences that increase the prevalence and morbidity of this chronic manifestation of CHIKV infection.