Methotrexate and TNF-Blockers for Post Chikungunya Chronic Arthritis : The Martinican Experience

Marie Blettery¹, Lauren Brunier-Agot², JULIA MARY³, Katlyne Polomat⁴, Florence MOINET⁴, Christophe Deligny⁵, Serge ARFI⁶, Georges JEAN BAPTISTE⁷ and Michel De Bandt⁸, ¹rheumatology, CHU Fort de France, Fort de France, Martinique, ²Internal medicine and rheumatology, Zobda Quitman Hospital, Fort de France, Martinique, ³RHEUMATOLOGY, CHU Fort de France, 97261, Martinique, ⁴Rheumatology and Internal Medicine, Zobda Quitman Hospital, Fort de France, Martinique, ⁵Zobda Quitman Hospital, Rheumatology and Internal Medicine, Fort de France, Martinique, ⁶University Hospital, CHU Fort de France, Fort de France, Martinique, ⁷RHEUMATOLOGY, CHU MARTINIQUE, FWI, Fort-de-France, Martinique, ⁸Rheumatology department, CHU Fort de France, Fort de France, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Biologic agents, Polyarthritis and viruses

Session Information

Date: Monday, November 14, 2016

Title: Infection-related Rheumatic Disease - Poster

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: To describe treatments in patients with chronic post-chikungunya polyarthritis seen during the Caribbean outbreak (December 2013 – January 2015).

Methods: Patients were examined by senior rheumatologists, using a standard care-report form, post-CHIK polyarthritis was diagnosed collectively. Treatments were introduced following recommendation of the French Society of Rheumatology.

Results: Among 147 patients, 45 (30.6%) met criteria of spondyloarthritis. In all cases the rheumatic diseases predated CHIKV infection and exacerbated at the waning of the acute viral infection, despite NSAID(s), justifying further therapeutic intensification with DMARDs (MTX 17/45, mean dose 20 mg/w) and anti- TNF (7/45). Mean follow-up was 6.5 months, during which time the patients’ mean BASDAI±SD decreased from 5.1 ± 1.5 at the first visit to 3.8 ± 1.5 at the last one. 27 patients (18.3%), developed de novo polyarthritis in response to CHIKV infection. None had CHIKV-positive PCR during polyarthritis. Biologic inflammation was moderate (mean CRP 25 ± 12 mg/liter), serologic work-up was negative for all patients. All received MTX (mean dose 21 mg/w), with good responses in 21/28, while 7/28 required anti-TNF. Mean follow-up was 7 months, during which mean DAS28score ± SD decreased from 4.8 ± 1.5 at the first visit to 3.3 ± 1.5 at the last one. They received biologics at conventional doses (etanercept 11 and adalimumab 3). Tolerance was good without any recurrence of the viral infection manifestations, as previously described (18). Efficacy was as expected for this type of pathology.

Conclusion: The term “chronic CHIK syndrome” covers multiple etiologies. These patients should be managed by rheumatologists as early as possible to avoid late treatment onset. Compliance with the French Society of Rheumatology recommendations, assure early therapeutic intervention. Simon F, Javelle E, Cabie A, Bouquillard E, Troisgros O, Gentile G, et al. French guidelines for the management of chikungunya (acute and persistent presentations). Méd Mal Infect 2015;45:243–63.

Disclosure: M. Blettery, None; L. Brunier-Agot, None; J. MARY, None; K. Polomat, None; F. MOINET, None; C. Deligny, None; S. ARFI, None; G. JEAN BAPTISTE, None; M. De Bandt, None.

To cite this abstract in AMA style:

Blettery M, Brunier-Agot L, MARY J, Polomat K, MOINET F, Deligny C, ARFI S, JEAN BAPTISTE G, De Bandt M. Methotrexate and TNF-Blockers for Post Chikungunya Chronic Arthritis : The Martinican Experience [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/methotrexate-and-tnf-blockers-for-post-chikungunya-chronic-arthritis-the-martinican-experience/. Accessed .

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