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.
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.
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 November 17, 2019.
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