title: Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study.
abstract: BACKGROUND
  Arthritogenic alphaviruses, including Chikungunya virus (CHIKV), are responsible for acute fever and arthralgia, but can also lead to chronic symptoms. In 2006, a Chikungunya outbreak occurred in La Réunion Island, during which we constituted a prospective cohort of viremic patients (n = 180) and defined the clinical and biological features of acute infection. Individuals were followed as part of a longitudinal study to investigate in details the long-term outcome of Chikungunya.
  
  
  RESULTS
  Patients were submitted to clinical investigations 4, 6, 14 and 36 months after presentation with acute CHIKV infection. At 36 months, 22 patients with arthralgia and 20 patients without arthralgia were randomly selected from the cohort and consented for blood sampling. During the 3 years following acute infection, 60% of patients had experienced symptoms of arthralgia, with most reporting episodic relapse and recovery periods. Long-term arthralgias were typically polyarthralgia (70%), that were usually symmetrical (90%) and highly incapacitating (77%). They were often associated with local swelling (63%), asthenia (77%) or depression (56%). The age over 35 years and the presence of arthralgia 4 months after the disease onset are risk factors of long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases. These data helped define the features of CHIKV-associated chronic arthralgia and permitted an estimation of the economic burden associated with arthralgia.
  
  
  CONCLUSIONS
  This study demonstrates that chronic arthralgia is a frequent complication of acute Chikungunya disease and suggests that it results from a local rather than systemic inflammation.
authors.affiliation: Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Schilte
authors.forename: Frederik
authors.initials: F
authors.lastname: Staikowsky
authors.forename: Frédérik
authors.initials: F
authors.lastname: Staikovsky
authors.forename: Thérèse
authors.initials: T
authors.lastname: Couderc
authors.forename: Yoann
authors.initials: Y
authors.lastname: Madec
authors.forename: Florence
authors.initials: F
authors.lastname: Carpentier
authors.forename: Somar
authors.initials: S
authors.lastname: Kassab
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Albert
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
authors.forename: Alain
authors.initials: A
authors.lastname: Michault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018354:Alphavirus Infections / Q000150:complications* / Q000453:epidemiology; D018771:Arthralgia / Q000453:epidemiology / Q000473:pathology*; D065632:Chikungunya Fever; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017508:Reunion / Q000453:epidemiology; D012307:Risk Factors
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