title: Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis.
abstract: To determine the percentage of patients who would develop chronic inflammatory rheumatism (CIR) following chikungunya (CHIK) virus disease.
  
  
  
  We conducted a systematic review of the literature in 3 databases (PubMed, Science Citation Index, and Scopus) to identify studies assessing the proportion of patients who progress to CHIK-CIR. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence intervals (95% CIs). A 2-tailed alpha level of 5% was used for hypothesis testing. Measures of heterogeneity, including Cochran's Q statistic, the I2index, and the tau-squared test, were calculated and reported. Subgroup analyses were conducted by type of study and country, by studies evaluating chronic arthritis, and by studies with ≥200 patients and followup ≥18 months. Publication bias was assessed using a funnel-plot.
  
  
  
  Up to June 15, 2015, our literature search yielded 578 citations. The pooled prevalence of CHIK-CIR in 18 selected studies among 5,702 patients was 40.22% (95% CI 31.11-49.34; τ2= 0.0838). From studies derived from India, prevalence was 27.27% (95% CI 15.66-38.88; τ2= 0.0411), while from France, prevalence was 50.25% (95% CI 25.38-75.12; τ2= 0.1797). The prevalence of CHIK chronic arthritis was 13.66% (95% CI 9.31-18.00; τ2= 0.0060). Considering just those studies with ≥200 patients assessed, prevalence was 34.14% (95% CI 23.99-44.29; τ2= 0.0525). In studies with a followup ≥18 months, prevalence was 32.13% (95% CI 22.21-42.04; τ2= 0.0453).
  
  
  
  According to our results in the most conservative scenario, approximately 25% of CHIK cases would develop CHIK-CIR (34% if we just consider the most representative studies), and 14% would develop chronic arthritis.
authors.affiliation: Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, and Organización Latinoamericana para el Fomento de la Investigación en Salud, Bucaramanga, Santander, Colombia.
authors.forename: Alfonso J
authors.initials: AJ
authors.lastname: Rodríguez-Morales
authors.affiliation: Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Cardona-Ospina
authors.affiliation: Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia.
authors.forename: Sivia
authors.initials: S
authors.lastname: Fernanda Urbano-Garzón
authors.affiliation: Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia.
authors.forename: Juan
authors.initials: J
authors.lastname: Sebastian Hurtado-Zapata
mesh_terms: D000328:Adult; D016918:Arthritis, Reactive / Q000453:epidemiology* / Q000821:virology; D065632:Chikungunya Fever / Q000150:complications* / Q000821:virology; D002646:Chikungunya virus; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence