A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years

Autor(es): Bouquillard Eric, Combe Bernard


Resumo: In 2005, after an epidemic infection of Chikungunya fever in isl-s in the Indian Ocean, infected patients exhibited severe musculoskeletal disorders. We report 21 cases of rheumatoid arthritis (RA) after Chikungunya infection that were diagnosed at a rheumatological centre in Reunion Isl-. Patients were examined by the same rheumatologist from February 2006 to July 2007. Inclusion criteria were (1) Chikungunya infection confirmed by IgM - IgG antibodies, (2) RA according to ACR criteria, (3) no other definite diagnosis of arthritis - (4) persistent arthritis symptoms from the onset of viral infection to RA diagnosis. Twenty-one patients (13 females; mean age, 57+/-12 years) fulfilled the inclusion criteria. Eighteen patients (85.7%) had symmetric polyarthritis - three had oligoarthritis. The mean symptom duration was 10 months (range 4-18). The mean ESR was 40.7+/-28.1 mm/hr - C-reactive protein level 37+/-41 mg/l; 12 patients were positive for rheumatoid factor (57.1%), - six had anti-CCP antibodies (28.6%) - 14 HLA DRB1*04 or 01 alleles (66.6%). Radiographs of h-s - feet of 12 patients showed erosions -/or joint space narrowing (JSN). During a mean follow-up of 27.6+/-6.4 months, all patients were treated with DMARDs including methotrexate (n=19) - TNF blockers (n=6). Structural damage progressed, with 17 cases of erosion -/or JSN at follow-up. We diagnosed RA in 21 patients with Chikungunya fever. The first symptoms occurred at the time of viral infection. Outcome was severe in most of the cases despite low rate of anti-CCP antibodies. These cases suggest a role of viral infection in RA initiation.


Palavras-Chave: Rheumatoid arthritis; Chikungunya fever; Viral arthropathy; Alphavirus


Imprenta: Joint Bone Spine, v. 76, n. 6, p. 654-657, 2009


Identificador do objeto digital: 10.1016/j.jbspin.2009.08.005


Descritores: Chikungunya virus - Pathogenesis ; Chikungunya virus - Proteins ; Chikungunya virus - Antibodies ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemic ; Chikungunya virus - Epidemiology ; Chikungunya virus - Immunology ; Chikungunya virus - Public health


Data de publicação: 2009