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Persistent rheumatic musculoskeletal pain and disorders at one year post-chikungunya epidemic in south Maharashtra—a rural community based observational study with special focus on naïve persistent rheumatic musculoskeletal cases and selected cytokine expression

2011; Medknow; Volume: 6; Issue: 1 Linguagem: Inglês

10.1016/s0973-3698(11)60023-x

0973-3701

Arvind Chopra, V Anuradha,

Viral Infections and Vectors

The recent Chikungunya (CHIKV) epidemic (2006) unleashed an unrecognized spectrum of rheumatic musculoskeletal (RMSK) pain and disorders. The data on persistent RMSK is lacking. About 10% clinical acute cases are considered to suffer from chronic arthritis. We used an arthritis camp approach in a 9000 populated village Modnimb (district Sholapur) in December 2007 to identify naive cases of RMSK following symptomatic CHIKV outbreak in December 2006. A 10-day intensive publicity through public announcement and media pamphlet distribution program was carried out to attract villagers with persistent aches and pains and a past history of acute CHIKV illness to attend a 3 day free of cost evaluation arthritis camps. Blood samples were collected from consenting patients. Village volunteers and health workers participated in it. 1.4 percent (95% confidence interval 1.13, 1.60) village population was found to suffer from naive persistent RMSK pain and disorders at 1 year following acute CHIKV infection. Patients were generally >45 years age and females were predominant. Knee was the predominant pain site in 79% cases. Though 27% cases suffered from non-specific arthralgias (NSA), the diagnosis in 48% and 15% cases respectively was consistent with OA (often knee and spine) and undifferentiated inflammatory arthritis (0.2% crude prevalence). Overall, the clinical RMSK profile was benign and none reported any significant functional disability or mobility impairment. Seventy-three percent patients tested seropositive for anti-CHIKV IgG antibody; none for IgM antibody. None showed any abnormality on routine laboratory haematology and biochemistry testing; seropositive RF, ANA and anti-CCP was infrequent. Though CRP values were low, IL-6 was elevated and was not associated with any clinical phenotype. As compared to normal healthy population values assayed a year prior to the epidemic in a neighboring village, cases with persistent RMSK showed elevated IFN-γ, TNF-α and IL-13. Also, the clinical phenotype and cytokine expression did not seem to differ between the seropositive and seronegative groups for anti-CIKV IgG antibody. In this rural community study, at least 1.4% population continued to suffer from some form of RMSK at 1 year following acute CHIKV epidemic. Though clinically unimpressive, a large number showed elevated pro-inflammatory cytokine expression. A longer follow-up may explain this disconnect.