1Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
2Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
Am J Trop Med Hyg. 2021 Mar 8;104(5):1741-1746. doi: 10.4269/ajtmh.20-1573.
Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case-control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with mild disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-high disease activity and had substantial functional disability. Diabetes mellitus, chronic back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.
大多数关于慢性基孔肯雅病毒 (CHIKV) 关节炎的研究都包括接受疾病修饰抗风湿药物 (DMARDs) 治疗的患者，这可能改变了临床表现和结果的表达。因此，我们试图评估 DMARD 初治的慢性 CHIKV 关节炎患者的临床特征和相关性。我们在波多黎各进行了一项成年患者的病例对照研究，这些患者的血清学证实感染了 CHIKV。确定了人口统计学特征、临床表现、合并症、疾病活动度（根据临床疾病活动指数 [CDAI]）、功能状态（根据健康评估问卷残疾指数 [HAQ-DI]）和药物治疗情况。比较了患有和不患有慢性 CHIKV 关节炎的患者。此外，在研究就诊时表现为轻度疾病活动度与中重度疾病活动度的慢性 CHIKV 患者中进行了亚分析。总共有 61 名患者接受了研究；33 名患者患有慢性关节炎，28 名患者已痊愈关节炎。慢性关节炎患者的糖尿病、慢性背痛和发热、疲劳和肌痛的发生率明显更高。平均（SD）HAQ 评分为 0.95（0.56），57.6%的患者为中重度疾病活动度。中度至重度疾病活动度的患者在总体 HAQ-DI 和 HAQ-DI 类别（穿衣和梳妆、起床、卫生、伸手和活动）的评分均高于轻度活动度的患者。总之，在这群 DMARD 初治的慢性 CHIKV 关节炎患者中，近 58%的患者为中重度疾病活动度，且存在严重的功能障碍。糖尿病、慢性背痛和急性感染时的一些表现与慢性 CHIKV 关节炎有关。
