Background/Purpose: A spectrum of post Chikungunya (Chik) arthritis , often RA like, were referred to an urban rheumatology centre (Pune India)during the 2006 epidemic (Arthritis & Rheumatism 2008). We examined 449 (51.3%) adult cases of acute Chik in a nearby rural survey (Bavi, Solapur) in 2006 ; 35% cases persisted with arthritis which reduced substantially by 6 months. Only 5% cases suffered non-specific arthralgias  (mostly knees, elevated IL-6) by 24 months (Epidemiol Infect 2012. In a prior rural survey (Ralegaon Sidhi) in 2003, we reported 27% painful MSK ( 0.8% undifferentiated IA, 0.3% clinical RA, 0.3% SpA (Ind J Rheumatol 2015). Sporadic cases of Chik related arthritis continue. In the current study, we demonstrate the impact of the earlier Chik epidemic 2006 on the current MSK arthritis landscape.

Methods: The WHO Community oriented program for control of rheumatic diseases Bhigwan model (J Rheumatol 2009) was used to identify MSK disorders arthritis ( > 16 years age) using standard questionnaire in a house to house survey in Bavi; May-Aug 2018. We verified residency from village records (including electoral)  and interviews. 2131 population (70% response, 49% women, 15% aged 65 years +) was screened and classified: 784 residents also surveyed in 2006 (BRS), 1120  residents not included in the 2006 survey (BRNS), 227 post 2006 migrants (BM); 127 had died. Most of the BRNS lived in the outskirts of Bavi. Clinical diagnosis was based on standard rheumatology approach. Blood samples (26% population) were assayed in the urban centre. Standard statistics included crude point prevalence; significant p< 0.05.

Results: 549 (25.7%) subjects suffered from painful MSK disorders, predominantly (¬80%) mild moderate and with mild HAQ disability. 206 cases (39.9%) recalled past acute Chik illness.  422 (61.7%) healthy subjects and 362 (80.6%) cases from the 2006 survey cohort were available; correspondingly 17.5%  healthy and  44.8% cases reported painful MSK (2018 survey).10 patients were diagnosed clinical RA (50% seropositive RF).  13 (2.5% ) cases (1 RA) in 2006 survey were seropositive (cut off 40 IU/ml) for RF; correspondingly 22 (4%) cases (5 RA,  440-1170 IU/ml) in 2018 survey. 6/22 seropositive RF cases (5 RA) tested seropositive for anti CCP. Table 1 & Table 2 show the classification break up (proportion) in the 2018 survey, and compares MSK per se with and without onset following CHIK; Abbreviations in text

Conclusion: A substantial burden and spectrum of painful MSK disorders, in particular related to Chik was demonstrated in this rural survey. There seemed to be an increase in inflammatory arthritis (not necessarily RA) following the Chik 2006 epidemic in this otherwise robust population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-burden-of-painful-arthritis-and-rheumatism-following-the-chikungunya-epidemic-2006-india-rural-population-survey-2018/