Background/Purpose: Between December 2013 and April 2016, the largest epidemic of Ebola virus disease (EVD) to date generated more than 28,000 cases and more than 11,000 deaths in the large, mobile populations of Guinea, Liberia, and Sierra Leone. However, based on the small size of past outbreaks in remote and resource-poor locations that hinder systematic study, there is little knowledge of the frequency of various sequelae post-EVD, their pathogenesis, and optimum treatment. Some short-term and long-term health problems have been reported such as arthralgia and/or maylagia¹.

Methods: The Postebogui study is a prospective multicenter cohort aiming to evaluate the long-term clinical, psychological and socio-behavioral outcomes of EVD survivors infected during the 2014-2015 outbreaks². Nearly 80% of survivors in Guinea were included in the Postebogui cohort. We organized the systematic rheumatic screening of all patients included in the Postebogui cohort (Conakry) regardless of the disease status. A musculoskeletal (MS) Doppler ultrasound (DUS) assessment was performed (Esaote MyLab). Data were collected using a standardized questionnaire and entered into an electronic database.

Results:

Of the 382 participants included in the Postebogui cohort in Conakry, 313 patients underwent a complete interview by a rheumatologist nearly 3-year after viral infection: 36 patients never presented joint or muscle pain, 61 patients had experienced previous pain and 216 patients still reported chronic MS pain (69%). No demographic differences were found between both groups except that children significantly reported less chronic MS pain.

In the painful group, 58% were female; median age was 29.1 years; median time from Ebola Treatment Center (ETC) discharge to rheumatologic examination was 36 months. Pain manifestations started before EVD for 41 patients (19%). Morning stiffness was present in 46% of patients. Patients had mechanical pain (48%), inflammatory pain (18%) or both (34%). Axial and peripheral were largely involved (84%). Large joints were most frequently affected (89%). Polyarticular presentations were predominant with a symmetrical pain distribution. Furthermore, 91% had at least one painful enthesitis. DUS showed 5 patients with tenosynovitis and 4 patients with synovitis but without hyperemia. One patient suffered with Pes anserine tendonitis. Diagnoses were mainly non-specific MS disorders (67%) and low back pain (39%). No rheumatoid arthritis was retained but axial spondyloarthritis with enthesitis was suspected in few cases (2%).

Conclusion: Our study provides the largest accurate description of MS disorders in the Post-Ebola syndrome with a long-term follow-up (3 year after Ebola infection). Rheumatic sequelae are frequent and pathophysiological mechanisms need to be explored in the future.

References

¹Pers YM et al. Rheumatology 2017

²Etard JF et al. Lancet Infectious Diseases 2017

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-rheumatic-and-musculoskeletal-disorders-associated-to-ebola-virus-infection/