Tanay Amir
Tel Aviv University Medical School, Tel Aviv-Yafo, Israel.
Curr Opin Rheumatol. 2017 Jul;29(4):389-393. doi: 10.1097/BOR.0000000000000396.
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus. Fever, rash and severe arthralgia are the hallmarks of chikungunya fever (CHIKF), the disease caused by this virus. The acute course of the disease usually lasts few weeks to months. Chronic, relapsing or persistent arthralgia and arthritis have been described mimicking rheumatoid arthritis (RA), requiring immunosuppressive drugs.The purpose of this review is to characterize both the chronic clinical course of CHIKF-associated arthritis and the immunological pathogenic mechanisms involved.
The effect of postepidemic chronic persistent rheumatic course on the functional status of affected individuals, affecting large populations, has been studied. One-third of affected individuals had persistent pain months to years postepidemic and the identified risk factors for functional disability were identified.Inflammatory biomarkers associated with disease severity of RA such as interleukin 6 (IL6), and relevant chemokines have been found to correlate with the severity of postepidemic chronic disease. There are conflicting reports on antinuclear antibodies (ANAs) as well as rheumatoid factor and anti-citrullinated peptide antibody (ACPA) sero-positivity during infections.According to a recent study, eight out of 10 infected individuals developed chronic persistent rheumatic course and met classification criteria for seronegative RA.In a flow cytology analyses, these eight patients, similar to a group of RA patients, had a greater percentage of activated and effector CD4 and CD8 T cells than healthy controls.
Patients with CHKV infections may have a chronic persistent course of musculoskeletal disease, overlapping clinical and immunologic features with RA patients. In the appropriate setting and awareness, CHIKV infection should be considered when a patient is evaluated with a new symmetric polyarthritis.The question to be raised: Is it possible that in genetic prone individuals and in a particular environmental and infectious setting, such as CHIKF outbreak, an autoimmune disease will emerge?
基孔肯雅病毒（CHIKV）是一种由蚊子传播的甲病毒。发热、皮疹和严重关节痛是基孔肯雅热（CHIKF）的特征，CHIKF是由该病毒引起的疾病。该疾病的急性病程通常持续数周或数月。已经描述了慢性、复发性或持续性关节痛和关节炎，类似于类风湿性关节炎（RA），需要使用免疫抑制药物。本综述的目的是描述CHIKF相关关节炎的慢性临床病程以及所涉及的免疫致病机制。
已研究了流行后慢性持续性风湿病程对受影响个体功能状态的影响，这些个体数量众多。三分之一的受影响个体在流行后数月至数年仍有持续性疼痛，并确定了功能残疾的危险因素。已经发现与RA疾病严重程度相关的炎症生物标志物，如白细胞介素6（IL6）和相关趋化因子，与流行后慢性病的严重程度相关。关于感染期间抗核抗体（ANA）以及类风湿因子和抗瓜氨酸化肽抗体（ACPA）血清阳性的报道存在矛盾。根据最近的一项研究，10名感染者中有8人出现慢性持续性风湿病程，并符合血清阴性RA的分类标准。在流式细胞术分析中，这8名患者与一组RA患者相似，其活化和效应CD4和CD8 T细胞的百分比高于健康对照。
CHKV感染患者可能有慢性持续性肌肉骨骼疾病病程，其临床和免疫特征与RA患者重叠。在适当的情况下并提高认识，当对新出现对称性多关节炎的患者进行评估时，应考虑CHIKV感染。需要提出的问题是：在遗传易感性个体以及特定的环境和感染背景下，如CHIKF爆发时，是否有可能出现自身免疫性疾病？
