title: Rheumatic-musculoskeletal pain and disorders in a naïve group of individuals 15 months following a Chikungunya viral epidemic in south India: a population based observational study.
abstract: BACKGROUND
  Prospective community data on arthropathy following Chikungunya (CHIKV), a self-limiting, arboviral infection, causing debilitating arthropathy are lacking. The clinical profile of chronic rheumatic-musculoskeletal (RMSK) pain and disorders, captured inadvertently about 15 months following a CHIKV epidemic is described.
  
  
  METHODS
  Patients with RMSK pain following the CHIKV epidemic in 2007 were identified from a randomly selected population of 5277 (Age > 15 years) in a village in south India, using a validated questionnaire-based house-to-house survey. Typical narration, records and serology were relied upon to classify CHIKV. Respondents who recorded active pain sites on a human mannequin were evaluated by Rheumatology physicians.
  
  
  RESULTS
  A total of 1396 CHIKV infected individuals with painful MSKD were identified, of whom 437 patients (mean age: 48.37 ± 13.62 years; 71.6% women) who were naïve to RMSK pain prior to the epidemic were studied in detail. Incidence of RMSK pain and disorders in the naïve group was 8.3% (437/5277). Knee was the commonest self-reported pain site (83.3%). Majority of the patients (57%) had postviral non-specific polyarthralgia. Soft tissue rheumatism was very common (27.7%). Rheumatoid arthritis and seronegative spondyloarthritis were observed in 6 and 11 patients, respectively.
  
  
  CONCLUSIONS
  Although a causal association could not be established, this study has unravelled a wide spectrum of unrecognised post-CHIKV chronic RMSK disorders. Aetiopathogenesis and risk factors of chronicity need to be studied further.
authors.affiliation: Department of Internal Medicine, Government Medical College Hospital, Trivandrum, Kerala, India. mathewaj@cmcvellore.ac.in
authors.forename: A J
authors.initials: AJ
authors.lastname: Mathew
authors.forename: V
authors.initials: V
authors.lastname: Goyal
authors.forename: E
authors.initials: E
authors.lastname: George
authors.forename: D V
authors.initials: DV
authors.lastname: Thekkemuriyil
authors.forename: B
authors.initials: B
authors.lastname: Jayakumar
authors.forename: A
authors.initials: A
authors.lastname: Chopra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018354:Alphavirus Infections / Q000453:epidemiology*; D065632:Chikungunya Fever; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000453:epidemiology* / Q000821:virology; D055815:Young Adult