title: Disability with Persistent Pain Following an Epidemic of Chikungunya in Rural South India.
abstract: OBJECTIVE
  We investigated the effects of chronic rheumatic and musculoskeletal symptoms on the functional status of people affected by the chikungunya (CKG) epidemic in the Calicut District, Kerala, South India in 2009.
  
  
  METHODS
  A cross-sectional house-to-house survey was conducted 18 months after the CKG epidemic to assess functional status of individuals with post-epidemic persistent pain. All respondents over age 15 years with persistent pain fitting the epidemiological case definition were included. Participants' functional status was assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI). Factors affecting severity of HAQ-DI were analyzed by ordinal regression.
  
  
  RESULTS
  Of 3869 subjects interviewed, 1195 (34.3%) had a positive history of CHIKV virus infection (epidemiological or confirmed); 36.28% (624/1720) of CKG-affected individuals had persistent pain 18 months post epidemic. Mean age of those affected was 48.22 ± 15.6 years; 23.2% had no disability, while 16.2% had moderate to severe disability on the HAQ-DI. Significant factors affecting severity of disability on HAQ-DI included previous rheumatic musculoskeletal disease (OR 2.27), joint and soft-tissue involvement (OR 3.74), only joint involvement (OR 2.14), female sex (OR 1.44), diet (OR 4.73), and history of joint swelling (OR 1.72).
  
  
  CONCLUSIONS
  Persistence of pain noted in post-CKG disease resulted in significantly deteriorated functional status of those affected.
authors.affiliation: From the Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.A.A. Rahim, MD, DNB, Associate Professor; R.J. Thekkekara, Senior Research Assistant; T.B. Xavier, MD, PGDHM, Professor, Department of Community Medicine; B.J. Paul, MD, DNB, PhD, Professor, Division of Rheumatology, Department of Medicine, Government Medical College. rahmaniyas@gmail.com.
authors.forename: Asma A
authors.initials: AA
authors.lastname: Rahim
authors.affiliation: From the Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.A.A. Rahim, MD, DNB, Associate Professor; R.J. Thekkekara, Senior Research Assistant; T.B. Xavier, MD, PGDHM, Professor, Department of Community Medicine; B.J. Paul, MD, DNB, PhD, Professor, Division of Rheumatology, Department of Medicine, Government Medical College.
authors.forename: Romy Jose
authors.initials: RJ
authors.lastname: Thekkekara
authors.affiliation: From the Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.A.A. Rahim, MD, DNB, Associate Professor; R.J. Thekkekara, Senior Research Assistant; T.B. Xavier, MD, PGDHM, Professor, Department of Community Medicine; B.J. Paul, MD, DNB, PhD, Professor, Division of Rheumatology, Department of Medicine, Government Medical College.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bina
authors.affiliation: From the Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.A.A. Rahim, MD, DNB, Associate Professor; R.J. Thekkekara, Senior Research Assistant; T.B. Xavier, MD, PGDHM, Professor, Department of Community Medicine; B.J. Paul, MD, DNB, PhD, Professor, Division of Rheumatology, Department of Medicine, Government Medical College.
authors.forename: Binoy J
authors.initials: BJ
authors.lastname: Paul
mesh_terms: D000328:Adult; D065632:Chikungunya Fever / Q000150:complications*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D012424:Rural Population; D012720:Severity of Illness Index
keywords: CHIKUNGUNYA; DISABILITY; EPIDEMIC; FUNCTIONAL STATUS; PERSISTENT PAIN; RURAL