Silva Monaíse M O, Kikuti Mariana, Anjos Rosângela O, Portilho Moyra M, Santos Viviane C, Gonçalves Thaiza S F, Tauro Laura B, Moreira Patrícia S S, Jacob-Nascimento Leile C, Santana Perla M, Campos Gúbio S, Siqueira André M, Kitron Uriel, Reis Mitermayer G, Ribeiro Guilherme S
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
Int J Infect Dis. 2021 Apr;105:608-616. doi: 10.1016/j.ijid.2021.03.003. Epub 2021 Mar 5.
To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities.
From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease.
Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95-2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01-1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48-1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log copies/μL for those with and without chronic arthralgia, respectively; P = 0.75).
These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
调查基孔肯雅热患者持续性关节痛的危险因素，并描述其对日常活动的影响。
2014年9月至2016年7月，一项监测研究纳入了巴西萨尔瓦多急性发热性疾病患者，采用IgM酶联免疫吸附试验或逆转录酶聚合酶链反应检测基孔肯雅病毒感染患者。通过电话随访确定疾病进展情况。
在153例随访病例中，65例（42.5%）报告慢性关节痛持续超过3个月，47例（30.7%）在访谈时（症状出现后约1.5年）仍有症状。慢性关节痛患者分别有93.8%和61.5%报告日常活动受限和精神困扰。女性[风险比（RR）1.79，95%置信区间（CI）1.95 - 2.69]和年龄（每增加1岁RR为1.02，95%CI 1.01 - 1.03）是慢性关节痛的独立危险因素。慢性关节痛与登革病毒合并感染（RR 0.97，95%CI 0.48 - 1.94）或诊断时基孔肯雅病毒载量无关（有和无慢性关节痛患者的基孔肯雅病毒RNA中位数分别为5.60和5.52 log拷贝/μL；P = 0.75）。
这些发现强化了慢性基孔肯雅关节痛的高发生率，并突出了与疼痛持续相关的严重残疾。迫切需要制定新策略以减轻基孔肯雅病毒传播，并为基孔肯雅热患者提供长期医疗援助。
