Autor(es): Javelle Emilie, Ribera Anne, Degasne Isabelle, Gaüzère Bernard-Alex, Marimoutou Catherine, Simon Fabrice

Resumo: Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical - economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients. We conducted a 6-year case series retrospective study in Reunion Isl- of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical - therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria. We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities - tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local -/or general anti-inflammatory drugs, - physiotherapy. Rheumatologists in Reunion Isl- managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical - inflammatory pCHIK disorders. We provide a diagnostic - therapeutic algorithm to help physicians deal with chronic patients, - to limit both functional - economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.

Imprenta: PLoS Neglected Tropical Diseases, v. 9, n. 3, p. e0003603, 2015

Identificador do objeto digital: 10.1371/journal.pntd.0003603

Descritores: Chikungunya virus - Pathogenesis ; Chikungunya virus - Infectious diseases ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemiology ; Chikungunya virus - Public health

Data de publicação: 2015

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