title: Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging.
abstract: This longitudinal follow-up study of 203 patients with serologically confirmed chikungunya (CHIK) virus infection describes the clinical features of CHIK fever during the first and tenth months of illness. During the acute stage CHIK fever presents with a wide array of symptoms. The foremost chronic symptoms at the end of a month were rheumatism (75%) and fatigue (30%). During the tenth month of follow-up the symptoms/signs observed were joint pain/swelling (46%), fatigue (13%) and neuritis (6%). The cure rate at the end of 9 months was 51%. Among the patients who had joint pain, 36% (34/94) met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis. A subpopulation of the patients with joint pain (20/94) was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody, and the joints were imaged by X-ray and magnetic resonance imaging (MRI). All tested negative for RF and one tested positive for anti-CCP. A radiolucent lesion in the X-ray was seen in the bones of five patients. The MRI findings were joint effusion, bony erosion, marrow oedema, synovial thickening, tendinitis and tenosynovitis. The study proves with relative certainty that CHIK arthritis is chronic inflammatory erosive arthritis, which has implications for management of the infection.
authors.affiliation: Regional Medical Research Centre (RMRC-ICMR), Post Bag No. 13, Dollygunj, Port Blair 744101, Andaman and Nicobar Islands, India.
authors.forename: Sathya Prakash
authors.initials: SP
authors.lastname: Manimunda
authors.forename: Paluru
authors.initials: P
authors.lastname: Vijayachari
authors.forename: Raghuraj
authors.initials: R
authors.lastname: Uppoor
authors.forename: Attayur Purushottaman
authors.initials: AP
authors.lastname: Sugunan
authors.forename: Shiv Shankar
authors.initials: SS
authors.lastname: Singh
authors.forename: Subhodh Kumar
authors.initials: SK
authors.lastname: Rai
authors.forename: Anakkathil Balan
authors.initials: AB
authors.lastname: Sudeep
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Muruganandam
authors.forename: Itta Krishna
authors.initials: IK
authors.lastname: Chaitanya
authors.forename: Dev Reddy
authors.initials: DR
authors.lastname: Guruprasad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018354:Alphavirus Infections / Q000150:complications*; D001168:Arthritis / Q000503:physiopathology / Q000821:virology*; D002646:Chikungunya virus / Q000302:isolation & purification; D002648:Child; D018450:Disease Progression; D006801:Humans; D007194:India; D007596:Joints; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult