Chikungunya, the emerging migratory rheumatism
2015; Elsevier BV; Volume: 15; Issue: 5 Linguagem: Inglês
10.1016/s1473-3099(15)70150-7
ISSN1474-4457
AutoresÉmilie Javelle, Philippe Gautret, Fabrice Simon,
Tópico(s)Malaria Research and Control
ResumoFelicity Burt and colleagues1Burt F Chen W Mahalingam S Chikungunya virus and arthritic disease.Lancet Infect Dis. 2014; 14: 789-790Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar recently highlighted the arthritogenic capacity of chikungunya and postulated that it might exacerbate or increase susceptibility to joint diseases, notably to rheumatoid arthritis. Recent clinical data from Reunion Island and India support this hypothesis.Acute febrile polyarthritis is often followed by chronic disorders, mainly affecting joints, tendons, and bones. The causality of chikungunya in joint symptoms is highly suggested by long-term comparison of infected and uninfected adults.2Marimoutou C Vivier E Oliver M Boutin J-P Simon F Morbidity and impaired quality of life 30 months after chikungunya infection: comparative cohort of infected and uninfected French military policemen in Reunion Island.Medicine (Baltimore). 2012; 91: 212-219Crossref PubMed Scopus (54) Google Scholar To better address pathogenesis and case management, we need to identify the different nosological entities of post-chikungunya musculoskeletal and rheumatic disorders, and first of all, to assess their inflammatory nature. The spectrum is wide: exacerbation of pain in previously sick or injured joints or bones, mechanical misbalance in susceptible joints, neuropathic pain, abarticular inflammation, periostitis, and multiple or focal persisting inflammation in synovium and tendons ranging from oedematous steroid-sensitive polyarthralgia up to authentic chronic inflammatory rheumatisms in about 5% of patients with chronic disease.3Essackjee K Goorah S Ramchurn SK Cheeneebash J Walker-Bone K Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus.Postgrad Med J. 2013; 89: 440-447Crossref PubMed Scopus (71) Google ScholarThese postinfective rheumatisms, mostly rheumatoid arthritis and spondylarthropathy, are the most severe presentations because they can destroy joints, impair daily life, and need heavy treatment with disease-modifying antirheumatic drugs. Chikungunya can also worsen pre-existing chronic inflammatory rheumatisms and lead to intensification of the treatment (adjunctive steroid course, change background drug; unpublished). However, so far, no evidence shows that chikungunya can induce or worsen osteoporosis, except after prolonged courses of systemic corticotherapy.Because international travel is an increasing source for chikungunya infection, persisting musculoskeletal disorders or rheumatic diseases are now reported in travellers returning to non-epidemic countries months to years after the acute stage.4Simon F Parola P Grandadam M et al.Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases.Medicine (Baltimore). 2007; 86: 123-137Crossref PubMed Scopus (233) Google Scholar We believe that travellers should be warned that chikungunya is not a negligible risk because of its biphasic evolution. Patients older than 70 years or suffering underlying diseases (cardiovascular, respiratory, neurological disorders, or systemic lupus) are at higher risk for complication or death in the acute stage. In the same way, an unfavourable rheumatic outcome with long-term impairment of quality of life is predictable after chikungunya for patients with one of several criteria: female sex, age older than 45 years, and any pre-existing osteoarticular disease (mostly degenerative osteoarthritis).3Essackjee K Goorah S Ramchurn SK Cheeneebash J Walker-Bone K Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus.Postgrad Med J. 2013; 89: 440-447Crossref PubMed Scopus (71) Google Scholar, 4Simon F Parola P Grandadam M et al.Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases.Medicine (Baltimore). 2007; 86: 123-137Crossref PubMed Scopus (233) Google Scholar, 5Sissoko D Malvy D Ezzedine K et al.Post-epidemic chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period.PLoS Negl Trop Dis. 2009; 3: e389Crossref PubMed Scopus (255) Google ScholarConsidering this point, travelling in an epidemic area should be discouraged for patients who are highly susceptible to acute complications or long-lasting arthritic diseases; if the travel cannot be cancelled or postponed, all measures to prevent diurnal mosquito bites are recommended: long clothes, repellents, bednets, insecticides, and air conditioning.We declare no competing interests. Felicity Burt and colleagues1Burt F Chen W Mahalingam S Chikungunya virus and arthritic disease.Lancet Infect Dis. 2014; 14: 789-790Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar recently highlighted the arthritogenic capacity of chikungunya and postulated that it might exacerbate or increase susceptibility to joint diseases, notably to rheumatoid arthritis. Recent clinical data from Reunion Island and India support this hypothesis. Acute febrile polyarthritis is often followed by chronic disorders, mainly affecting joints, tendons, and bones. The causality of chikungunya in joint symptoms is highly suggested by long-term comparison of infected and uninfected adults.2Marimoutou C Vivier E Oliver M Boutin J-P Simon F Morbidity and impaired quality of life 30 months after chikungunya infection: comparative cohort of infected and uninfected French military policemen in Reunion Island.Medicine (Baltimore). 2012; 91: 212-219Crossref PubMed Scopus (54) Google Scholar To better address pathogenesis and case management, we need to identify the different nosological entities of post-chikungunya musculoskeletal and rheumatic disorders, and first of all, to assess their inflammatory nature. The spectrum is wide: exacerbation of pain in previously sick or injured joints or bones, mechanical misbalance in susceptible joints, neuropathic pain, abarticular inflammation, periostitis, and multiple or focal persisting inflammation in synovium and tendons ranging from oedematous steroid-sensitive polyarthralgia up to authentic chronic inflammatory rheumatisms in about 5% of patients with chronic disease.3Essackjee K Goorah S Ramchurn SK Cheeneebash J Walker-Bone K Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus.Postgrad Med J. 2013; 89: 440-447Crossref PubMed Scopus (71) Google Scholar These postinfective rheumatisms, mostly rheumatoid arthritis and spondylarthropathy, are the most severe presentations because they can destroy joints, impair daily life, and need heavy treatment with disease-modifying antirheumatic drugs. Chikungunya can also worsen pre-existing chronic inflammatory rheumatisms and lead to intensification of the treatment (adjunctive steroid course, change background drug; unpublished). However, so far, no evidence shows that chikungunya can induce or worsen osteoporosis, except after prolonged courses of systemic corticotherapy. Because international travel is an increasing source for chikungunya infection, persisting musculoskeletal disorders or rheumatic diseases are now reported in travellers returning to non-epidemic countries months to years after the acute stage.4Simon F Parola P Grandadam M et al.Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases.Medicine (Baltimore). 2007; 86: 123-137Crossref PubMed Scopus (233) Google Scholar We believe that travellers should be warned that chikungunya is not a negligible risk because of its biphasic evolution. Patients older than 70 years or suffering underlying diseases (cardiovascular, respiratory, neurological disorders, or systemic lupus) are at higher risk for complication or death in the acute stage. In the same way, an unfavourable rheumatic outcome with long-term impairment of quality of life is predictable after chikungunya for patients with one of several criteria: female sex, age older than 45 years, and any pre-existing osteoarticular disease (mostly degenerative osteoarthritis).3Essackjee K Goorah S Ramchurn SK Cheeneebash J Walker-Bone K Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus.Postgrad Med J. 2013; 89: 440-447Crossref PubMed Scopus (71) Google Scholar, 4Simon F Parola P Grandadam M et al.Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases.Medicine (Baltimore). 2007; 86: 123-137Crossref PubMed Scopus (233) Google Scholar, 5Sissoko D Malvy D Ezzedine K et al.Post-epidemic chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period.PLoS Negl Trop Dis. 2009; 3: e389Crossref PubMed Scopus (255) Google Scholar Considering this point, travelling in an epidemic area should be discouraged for patients who are highly susceptible to acute complications or long-lasting arthritic diseases; if the travel cannot be cancelled or postponed, all measures to prevent diurnal mosquito bites are recommended: long clothes, repellents, bednets, insecticides, and air conditioning. We declare no competing interests. Chikungunya virus and arthritic diseaseChikungunya virus is a mosquito-borne alphavirus that has recently emerged in several explosive epidemics, causing febrile illness that can progress to painful and debilitating rheumatic disease. The virus continues to spread globally. Based on recent developments, we propose a potential link between chikungunya infection and other bone and joint diseases. Full-Text PDF Emergent chikungunya virus and arthritis in the AmericasThe Correspondence letter by Emilie Javelle and colleagues1 emphasises new insights into arthritic disease after chikungunya virus infection. We are gratified that new evidence is confirming our argument that chikungunya virus is likely to exacerbate or increase susceptibility to underlying joint diseases.2 The need to intensify drug treatment for underlying arthritis after chikungunya virus infection1 provides a clear example of the importance of chikungunya virus infection in these patients. We agree with Javelle and colleagues that it will be important to develop data about possible interactions between chikungunya virus bone pathology and osteoporosis. Full-Text PDF
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