Background/Purpose: Background/purpose. The first chikungunya fever outbreak in Brazil had its peak in the first half of 2016 and many patients with rheumatologic disease using biological disease-modifying antirheumatic drugs (bDMARD) and conventional synthetic disease-modifying antirheumatic drugs therapy (csDMARD) were affected by the disease. Although there was initially concerns about the use of drugs with immunosuppressive potential in patients with a viral infection, the clinical practice and a few case reports demonstrated that there were no major complications and the clinical course seems to be similar to healthy population. The aim of this study was to compare the clinical course of rheumatic patients with rheumatic diseases treated with bDMARD or csDMARD.

Methods: The patients included in this study was select from two centers in Pernambuco, participating in the Brazilian cohort of patients with rheumatic diseases using bDMARD or csDMARD. Data about the disease therapy for the rheumatic disease and the symptoms of Chikungunya fever were collected. All the patients had the rheumatic disease diagnosis before the Chikungunya fever Brazilian outbreak and underwent serologic testing for chikungunya virus (CHIKV) IgG. The clinical data and blood sample for serology testing was taken from July 2017 until July 2018.  

Results: We included 103 patients in the study and 74.7% were women; the most frequent previous rheumatologic diagnosis was rheumatoid arthritis (76.1%); 50.5% of the sample was on bDMARD therapy combined or not with csDMARD, of which 21% exclusively on biological use. The overall soroprevalence of CHIKV IgG was 40.8%; on bDMARD patients it was 36.5% and on csDMARD 46.4% (p=0.437). Among patients with positive CHIKV IgG, 26.2% had no typical Chikungunya fever symptoms (fever and joint pain). No differences were observed among the two groups regarding the number of patients with asymptomatic infection. There was no clinically significant difference in acute phase symptoms between the two groups of patients. Regarding the persistence time of Chikungunya fever musculoskeletal symptoms in CHIKV IgG positive group, 85.7% of patients using bDMARD recovered up to 3 months compared to 47.1% in the non bDMARD group (p=0.029). In addition, the bDMARD group switched the treatment less frequently after CHIKV infection (p=0.0001).

Conclusion: The bDMARD seems to be associated with a shorter period of Chikungunya fever symptoms and lower frequency of flare triggered by CHIKV infection comparing to csDMARD. No difference was observed between the severity of the symptoms in both groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biological-therapy-is-associated-with-faster-recovery-and-lower-frequency-of-switch-treatment-in-patients-with-chikungunya-fever/