Department of Rheumatology, Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Ceará, Brazil.
Regional University of Cariri, Crato, Ceará, Brazil.
Curr Rheumatol Rev. 2024;20(3):337-346. doi: 10.2174/0115733971278715231208114037.
Chikungunya fever is a reemerging epidemic disease caused by a single-stranded RNA alphavirus transmitted throughout by Aedes mosquitoes. Chikungunya virus infection is a biphasic disease in which 72% to 95% of affected individuals manifest acute chikungunya fever. Following the acute phase, more than 40% of affected individuals develop arthritis, often lasting more than 3 months, referred to as chronic chikungunya arthritis, which frequently mimics rheumatoid arthritis.
This study aimed to evaluate the efficacy and safety of treatment of chronic chikungunya arthritis with methotrexate and dexamethasone in a randomized, double-blind, placebo-controlled clinical trial.
The patients were reassessed for treatment response by the DAS28-ESR, tender joint count and swollen joint count, Patient Global Assessment, and for secondary measures, including the Health Assessment Questionnaire Disability Index and Pain Visual Analog Scale.
Thirty-one subjects were randomized (placebo, n = 16; methotrexate, n = 15); 27 completed treatment and 4 discontinued during the 8-week blinded period. Among the participants, 96.8% were female, with mean ± SD age was 52.9 ± 13. The mean ± SD disease duration prior to treatment was 220.9 ± 51.2 days. At 8 weeks, methotrexate-treated subjects showed a greater numerical trend towards improvement, but there were no significant differences between methotrexate- dexamethasone group and dexamethasone (placebo) group.
In this relatively small cohort, all of whom received background dexamethasone, there was a greater numerical improvement trend in prespecified outcome measures, but methotrexate in combination with dexamethasone was not superior to dexamethasone in chronic chikungunya arthritis.
基孔肯雅热是一种由单链 RNA 披膜病毒引起的再流行传染病，通过伊蚊传播。基孔肯雅病毒感染是一种双相疾病，其中 72%至 95%的受感染者表现为急性基孔肯雅热。在急性期后，超过 40%的受感染者会出现关节炎，通常持续 3 个月以上，称为慢性基孔肯雅关节炎，常模仿类风湿关节炎。
本研究旨在评估甲氨蝶呤联合地塞米松治疗慢性基孔肯雅关节炎的疗效和安全性，这是一项随机、双盲、安慰剂对照临床试验。
通过 DAS28-ESR、压痛关节数和肿胀关节数、患者总体评估，以及包括健康评估问卷残疾指数和疼痛视觉模拟量表在内的次要措施，对治疗反应进行重新评估。
31 名受试者被随机分组（安慰剂，n=16；甲氨蝶呤，n=15）；27 名受试者完成了 8 周的双盲治疗，4 名受试者在治疗期间退出。参与者中，96.8%为女性，平均年龄±标准差为 52.9±13 岁。治疗前的平均疾病持续时间±标准差为 220.9±51.2 天。8 周时，甲氨蝶呤治疗组的改善趋势更为明显，但与甲氨蝶呤-地塞米松组和地塞米松（安慰剂）组相比，差异无统计学意义。
在这一小队列中，所有患者均接受背景地塞米松治疗，预先设定的结局指标显示出更大的改善趋势，但甲氨蝶呤联合地塞米松在慢性基孔肯雅关节炎中的疗效并不优于地塞米松。
