Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Chikungunya
virus (CHIKV) infection causes an acute febrile illness usually accompanied by
severe polyarthralgia and polyarthritis. Previous studies have shown that older age, female
gender and some comorbid conditions are associated with chronic arthritis. However, the factors associated with acute arthralgia or arthritis are not
well known. Thus, we studied the
clinical manifestations associated with acute peripheral arthralgia/arthritis
in a group of CHIKV patients from Puerto Rico.
Methods: As part of an acute
febrile illness surveillance project, patients with fever or history of fever
for ≤ 7 days evaluated at the emergency room of a community hospital
in Puerto Rico were tested for several pathogens including CHIKV. All patients with
positive CHIKV testing by either polymerase chain reaction
or IgM enzyme-linked immunosorbent assays from June
2014 to September 2014 were studied. Demographic
features, clinical manifestations, and comorbidities were determined. Patients
with peripheral arthralgia and/or arthritis were
compared to those without peripheral joint symptoms. To examine the differences
between the study groups we used bivariable and
multivariable analyses adjusting for confounding variables.
Results: In total, 172 patients with CHIKV infection were
evaluated, of which 52.9% were female. The mean (standard deviation [SD]) age
was 21.1 (± 19.3); 65.5% were
≤ 16 years of age, 25.7% were 17–54 years of age, and 8.8% were ≥ 55
years of age. Peripheral arthralgia/arthritis were
seen in 156 (90.7%) patients, of whom 49 (31.4%) had signs of synovitis. In the
bivariable analysis, patients with CHIKV
arthralgias/arthritis were more likely to be older (21.3 [± 19.6] years vs. 8.2 [± 10.3] years, p < 0.01) and to have more myalgias (85.9% vs. 50.0%, p < 0.01), back pain (63.5% vs. 6.2%,
p < 0.01), headaches (87.2% vs.
50.0%, p < 0.01), orbital pain
(47.4% vs. 6.2%, p < 0.01), anorexia
(71.8% vs. 37.5%, p < 0.01), nausea
(62.8% vs. 18.8%, p < 0.01), and
dizziness (48.1% vs. 12.5%, p < 0.01)
than those without with peripheral joint involvement. No associations were
found for gender, rash, pulmonary symptoms, cardiac manifestations, vomiting,
diarrhea, abdominal pain, hematologic abnormalities,
elevation of liver enzymes, renal manifestations, or comorbidities such as
diabetes, hypertension, cardiac disease, asthma, chronic kidney disease and
malignancy. The multivariable analysis is shown in the table.
Clinical manifestations associated with
acute peripheral arthralgias/arthritis
|
Clinical features
|
OR (95% CI)
|
p value
|
|
Myalgias |
4.65 (1.48 – 14.72) |
<0.01 |
|
Back pain |
16.77 (3.07 – 313.82) |
<0.01 |
|
Headache |
3.63 (1.06 – 12.53) |
<0.05 |
|
Ocular pain |
8.88 (1.65 – 165.19) |
<0.05 |
|
Anorexia |
5.68 (1.87 – 18.97) |
<0.01 |
|
Nausea |
6.88 (2.05 – 31.49) |
<0.01 |
|
Dizziness |
4.07 (0.98 – 27.69) |
0.10 |
Conclusion: In this
population of patients with acute CHIKV infection, peripheral joint involvement
was associated with myalgias and back pain as well as non musculoskeletal
manifestations such as headaches, ocular pain, anorexia and nausea. Clinicians
should be aware that this constellation of symptoms is common in these
patients.
To cite this abstract in AMA style:
Arroyo-Ávila M, Cabán A, Irizarry-Pérez M, Torres H, García EJ, Gorbea H, Vilá LM. Clinical Manifestations Associated with Peripheral Joint Involvement in Patients with Acute Chikungunya Virus Infection [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-manifestations-associated-with-peripheral-joint-involvement-in-patients-with-acute-chikungunya-virus-infection/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-manifestations-associated-with-peripheral-joint-involvement-in-patients-with-acute-chikungunya-virus-infection/