Cross-Sectional Analysis of Chikungunya Arthritis Patients 22-Months Post-Infection Demonstrates a Lack of Viral Persistence in Synovial Fluid

Aileen Chang¹, Karen Martins* Contributed equally², Liliana Encinales³, St. Patrick Reid⁴, Marlon Acuña³, Carlos Encinales³, Christian Matranga⁵, Nelly Pacheco³, Carlos Cure³, Bhavarth Shukla⁶, Teofilo Arteta Ruiz³, Richard Amdur⁷, Lisa Cazares⁸, Melissa Gregory⁸, Michael Ward⁸, Alexandra Porras⁹, Alejandro Rico Mendoza⁹, Lian Dong⁸, Tara Kenny⁸, Ernie Brueggemann⁸, Lydia Downey⁸, Priyanka Kamalapathy⁷, Paola Lichtenberger⁶, Orlando Falls³, Gary Simon⁷, Jeffrey Bethony⁷ and Gary S. Firestein¹⁰, ¹Medicine, George Washington University, Washington, DC, ²United States Army Medical Research Institute for Infectious Disease, Frederick, MD, ³Allied Research Society, Baranquilla, Colombia, ⁴University of Nebraska, Omaha, NE, ⁵Broad Institute, Boston, MA, ⁶University of Miami, Miami, FL, ⁷George Washington University, Washington, DC, ⁸United States Army Medical Research Institute of Infectious Disease, Frederick, MD, ⁹Allied Research Society, Bogota, Colombia, ¹⁰Medicine, UCSD, La Jolla, CA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Arthritis management and infection

Session Information

Date: Tuesday, November 7, 2017

Title: Infection-related Rheumatic Disease

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Chikungunya virus infection is a mosquito-borne disease that causes chronic joint pain for months to years in approximately one half of infected patients. The study objective was to determine if chikungunya virus (CHIKV) persists in the synovial fluid, potentially serving as a causative mechanism of persistent arthritis.

Methods:

Design: Cross-sectional

Setting: Atlántico and Bolívar Departments, Colombia

Participants: Thirty-eight patients with CHIKV infection during the 2014-2015 epidemic with chronic arthritis, including in the knee joint, and ten healthy controls without prior CHIKV infection were included.

Measures: Participants completed a symptom questionnaire. Prior infection with CHIKV was confirmed by serological analysis. The presence of chikungunya viral RNA in blood and synovial fluid were measured by qPCR.

Results: Prior CHIKV infection was serologically confirmed in 33/38 (87%) of the cases based on IgM (3%) and IgG ELISA (100%). Confirmed chikungunya arthritis patients were predominantly women (82%), Afro-Colombian (55%), or White-Colombian (33%) with high school or less level of education (94%). CHIKV arthritis patients were a median 22 (IQR 21-23) months post CHIKV infection. Initial symptoms of CHIKV infection included joint pain (97%), joint swelling (97%), joint stiffness (91%), fever (91%), and rash (88%). The most commonly affected joints during initial infection were knees (87%), elbows (76%), wrists (75%), fingers (56%), and toes (56%). None of the participants were qPCR positive for persistent virus in the serum or synovial fluid. Furthermore, no viral proteins were identified in synovial fluid by mass spectrophotometry and synovial fluid was also culture negative. Participants reported an effect on their activities of daily living from their arthritis (82%) and disease severity was moderate, as shown by an average Disease Activity Score-28 of 4.52 ± 0.77.

Conclusion: This is one of the largest observational studies involving chikungunya arthritis patients. Synovial fluid analysis revealed no evidence of CHIKV by PCR, mass spectrometry, or culture. This suggests that immunomodulating medications may be safe in the treatment of chikungunya arthritis and suggests a possible mechanism whereby CHIKV causes arthritis through induction of host autoimmune pathology.

Disclosure: A. Chang, None; K. Martins* Contributed equally, None; L. Encinales, None; S. P. Reid, None; M. Acuña, None; C. Encinales, None; C. Matranga, None; N. Pacheco, None; C. Cure, None; B. Shukla, None; T. Arteta Ruiz, None; R. Amdur, None; L. Cazares, None; M. Gregory, None; M. Ward, None; A. Porras, None; A. Rico Mendoza, None; L. Dong, None; T. Kenny, None; E. Brueggemann, None; L. Downey, None; P. Kamalapathy, None; P. Lichtenberger, None; O. Falls, None; G. Simon, None; J. Bethony, None; G. S. Firestein, None.

To cite this abstract in AMA style:

Chang A, Martins* Contributed equally K, Encinales L, Reid SP, Acuña M, Encinales C, Matranga C, Pacheco N, Cure C, Shukla B, Arteta Ruiz T, Amdur R, Cazares L, Gregory M, Ward M, Porras A, Rico Mendoza A, Dong L, Kenny T, Brueggemann E, Downey L, Kamalapathy P, Lichtenberger P, Falls O, Simon G, Bethony J, Firestein GS. Cross-Sectional Analysis of Chikungunya Arthritis Patients 22-Months Post-Infection Demonstrates a Lack of Viral Persistence in Synovial Fluid [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/cross-sectional-analysis-of-chikungunya-arthritis-patients-22-months-post-infection-demonstrates-a-lack-of-viral-persistence-in-synovial-fluid/. Accessed .

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cross-sectional-analysis-of-chikungunya-arthritis-patients-22-months-post-infection-demonstrates-a-lack-of-viral-persistence-in-synovial-fluid/