Chikungunya Fever Outbreak in Brazil: Preliminary Assessment in a Cohort of Patients with Rheumatological Manifestations

Claudia Marques¹, Nara Cavalcanti², Mariana Luna³, Paula Toche², Carolina Andrade², Andrea Dantas², Aline Ranzolin², Laurindo Rocha Jr⁴, Eutília Freire⁵, Pablo Cardoso⁶, Kamila Vilar⁷, Michelly Pereira⁸, Moacyr Rêgo⁸, Maira Pitta⁶ and Angela Duarte⁹, ¹Hospital das Clínicas, Universidade Federal de Pernambuco, Recife - PE, Brazil, ²Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil, ³Universidade Federal de Pernambuco, Recife, Brazil, ⁴Rheumatology, Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, Brazil, ⁵Universidade Federal da Paraíba, João Pessoa, Brazil, ⁶Departamento de Bioquímica, Laboratório de Imunomodulação e Novas Abordagens Terapêuticas - UFPE, Recife, Brazil, ⁷Departamento de bioquímica, Laboratório de Imunomodulação e Novas Abordagens Terapêuticas - UFPE, Recife, Brazil, ⁸Bioquimica, Laboratório de Imunomodulação e Novas Abordagens Terapêuticas - UFPE, Recife, Brazil, ⁹Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Arthritis and infection

Session Information

Date: Monday, November 14, 2016

Title: Infection-related Rheumatic Disease - Poster

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Chikungunya virus (CHIKV) emerged in Brazil in September 2014. Since then the infection reached epidemic proportions in the country, paticularly in the Northeast region of Brazilian territory. Clinical manifestations of CHIKV infection involve various organs (skin, gastrointestinal tract, vascular system); however, rheumatic manifestations are the most typical features. The disability present in the chronic articular disease in CHIKV infection is an emerging challenge for rheumatologists. Objectives: To describe clinical manifestations associated with CHIKV infection in the Brazil population, in patients with previous rheumatic diseases and without previous rheumatic diseases.

Methods: From April to June 2016, 122 patients were enrolled with clinical and epidemiological diagnosis of CHIKV infection, 75 with IGG serology positive for CHIKV (ELISA, Euroimmun®).

Results: Thirty three patients (27.0%) presented a rheumatic disease prior to CHIKV infection (19 rheumatoid arthritis, 8 ankylosing spondylitis and 6 systemic lupus erythematosus). Most of the patients were women (80.3%), non-caucasians (85.0%) and the median age was 53.5 (±11.97) years. Patients had a median time of symptons of 10.8 (±7.46) weeks at the moment of enrollment. All of the patients presented joint pain, 87.0% presented characteristic inflammatory joint stiffness and 87.7% presente arthritis, with an additive polyarticular pattern in most of the cases. Pain intensity measured by visual analogue scale (VAS) was 6.36 (±2.52) and stiffness was 7.44 (±2.11); the median number of painful joints per patient was foi 11.9 (±17.9) and swollen joitns was 7.3 (±9.10). From the 122 patients, 53 (42.63%) had positive CHIKV IgM and 13.9% had a negative result; among the positives, 44.9% retained the positivity after 12 weeks of disease onset. There was significant association between IgM positivity and the number of painful joints by physical examination (p=0.001). There was no difference in clinical manifestations between patients with prior rheumatic diseases and patients whithout prior rheumatic diseases. Most of patients with prior rheumatic diseaes (50%) were under biological therapy (mainly TNF-blockers). There was no association between biological therapy use either with time of symtpons or joint pain characteristics. No disesase complications were observed in patients under immunossuppressor treatment and under disease modifying rheumatic drugs, biological or non-biological.

Conclusion: Initial data of CHIKV infection in brazilian population with prior rheumatic diseases suggest that there are no clinical differences from individuals with no prior rheumatologic disesases. The use of biological drugs seems not to be associated with either clinical complications or changes in the characteristic features of the symptons related to CHIKV infection. The persistence of positivity for IgM beyond 12 weeks may be a factor associated with chronicity of joint symptoms in FC .

Disclosure: C. Marques, None; N. Cavalcanti, None; M. Luna, None; P. Toche, None; C. Andrade, None; A. Dantas, None; A. Ranzolin, None; L. Rocha Jr, None; E. Freire, None; P. Cardoso, None; K. Vilar, None; M. Pereira, None; M. Rêgo, None; M. Pitta, None; A. Duarte, None.

To cite this abstract in AMA style:

Marques C, Cavalcanti N, Luna M, Toche P, Andrade C, Dantas A, Ranzolin A, Rocha Jr L, Freire E, Cardoso P, Vilar K, Pereira M, Rêgo M, Pitta M, Duarte A. Chikungunya Fever Outbreak in Brazil: Preliminary Assessment in a Cohort of Patients with Rheumatological Manifestations [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/chikungunya-fever-outbreak-in-brazil-preliminary-assessment-in-a-cohort-of-patients-with-rheumatological-manifestations/. Accessed .

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