Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Brazil.
Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Trop Med Hyg. 2023 Aug 7;109(3):542-547. doi: 10.4269/ajtmh.23-0205. Print 2023 Sep 6.
Chikungunya fever is a global vector-borne viral disease. Patients with acute chikungunya are usually treated symptomatically. The arthritic phase may be self-limiting. However, many patients develop extremely disabling arthritis that does not improve after months. The aim of this study was to describe the treatment of chikungunya arthritis (CHIKA) patients. A medical records review was conducted in 133 CHIKA patients seen at a rheumatology practice. Patients were diagnosed by clinical criteria and confirmed by the presence of anti-chikungunya IgM. Patients were treated with methotrexate (20 mg/week) and/or leflunomide (20 mg/day) and dexamethasone (0-4 mg/day) for 4 weeks. At baseline visit and 4 weeks after treatment, Disease Activity Score 28 (DAS28) and pain (using a visual analog scale) were ascertained. Five months after the end of treatment, patients were contacted to assess pain, tender joint count, and swollen joint count. The mean age of patients was 58.6 ± 13.7 years, and 119 (85%) were female. After 4 weeks of treatment, mean (SD) DAS28-erythrocyte sedimentation rate (6.0 [1.2] versus 2.7 [1.0], P < 0.001) and pain (81.8 [19.2] to 13.3 [22.9], P < 0.001) scores significantly decreased. A total of 123 patients were contacted 5 months after the end of treatment. Pain score, tender joint count, and swollen joint count significantly declined after 4 weeks of treatment, and the response was sustained for 5 months. In this group of patients with CHIKA, 4-week treatment induced a rapid clinical improvement that was maintained 5 months after the end of therapy; however, the contribution of treatment to these outcomes is uncertain.
基孔肯雅热是一种全球性的虫媒病毒病。急性基孔肯雅热患者通常采用对症治疗。关节炎期可能是自限性的。然而，许多患者会出现极其严重的关节炎，数月后仍未改善。本研究旨在描述基孔肯雅热关节炎（CHIKA）患者的治疗情况。对一家风湿病诊所的 133 例 CHIKA 患者的病历进行了回顾性分析。患者通过临床标准诊断，并通过抗基孔肯雅 IgM 的存在得到确认。患者接受甲氨蝶呤（20 mg/周）和/或来氟米特（20 mg/天）和地塞米松（0-4 mg/天）治疗 4 周。在基线访视和治疗 4 周后，评估疾病活动评分 28（DAS28）和疼痛（使用视觉模拟评分）。治疗结束后 5 个月，联系患者评估疼痛、压痛关节数和肿胀关节数。患者的平均年龄为 58.6±13.7 岁，119 例（85%）为女性。治疗 4 周后，平均（SD）DAS28-红细胞沉降率（6.0[1.2] 与 2.7[1.0]，P<0.001）和疼痛评分（81.8[19.2] 至 13.3[22.9]，P<0.001）显著降低。共有 123 例患者在治疗结束后 5 个月接受了联系。治疗 4 周后疼痛评分、压痛关节数和肿胀关节数显著下降，且反应持续 5 个月。在这组 CHIKA 患者中，4 周的治疗可迅速改善临床症状，且在治疗结束后 5 个月仍保持缓解；然而，治疗对这些结果的贡献尚不确定。
