Background/Purpose: Chronic chikungunya arthritis (CCA) is a long-term sequela of chikungunya virus infection marked by persistent pain, disability, and reduced quality of life. While nociplastic, neuropathic and nociceptive pain types have been described in other diseases, they remain understudied in CCA. This study aimed to classify pain phenotypes and evaluate clinical and social determinants associated with each phenotype among individuals with CCA.

Methods: We conducted a cross-sectional analysis of 117 participants enrolled in a clinical trial for CCA in an underserved population. Pain types were categorized using the PainDETECT Questionnaire and the Nociplastic-Based Fibromyalgia Features (NFF) tool. Disease activity and function were assessed using the Chikungunya Disease Activity Score (CHIK-DAS), Disease Activity Score-28 (DAS-28), Health Assessment Questionnaire (HAQ), and arthritis flare score. Social determinants of health (SDOH) were measured using a validated 10-item instrument. Bivariate analyses and multivariable logistic regression were used to examine associations between pain phenotypes and clinical/SDOH variables.

Results: Participants were predominantly female (78.6%), with a median age of 58 years and a median pain duration of 8.6 years. Nociplastic pain was the most prevalent phenotype (79.5%), followed by neuropathic (48.7%) and nociceptive (25.6%) pain. Nociplastic pain was significantly associated with longer pain duration (aOR = 1.02, 95% CI: 1.00–1.04) and sleep disturbance (aOR = 5.27, 95% CI: 1.92–14.44). Neuropathic pain was linked to higher disease activity (aOR = 1.12, 95% CI: 1.03–1.21), sleep disturbance (aOR = 2.47, 95% CI: 1.02–5.96), and medication insecurity (aOR = 4.17, 95% CI: 1.69–10.27). Nociceptive pain was inversely associated with CHIK-DAS (aOR = 0.91, 95% CI: 0.84–0.98) and less frequent among participants with medication insecurity (aOR = 0.33, 95% CI: 0.11–0.96) (Figure 1). Clinical burden was highest in those with nociplastic pain, while social vulnerability was more prominent in those with neuropathic components.

Conclusion: Pain in CCA is multidimensional, with nociplastic and neuropathic phenotypes predominating and associated with greater disease activity and functional impairment. Medication insecurity and sleep disturbance were key predictors of neuropathic pain, while nociplastic pain appeared more driven by chronicity and central sensitization. Incorporating SDOH screening and phenotype-specific assessments like CHIK-DAS may improve pain management strategies in post-viral arthritis.

Figure 1. Adjusted Odds Ratios (AORs) for Factors Associated with Pain Phenotypes in Chronic Chikungunya Arthritis. Forest plot showing multivariable-adjusted associations between clinical and social factors and the presence of neuropathic, nociceptive, and nociplastic pain components. Odds ratios are plotted on a log scale with 95% confidence intervals. Medication insecurity and higher CHIK-DAS scores were significantly associated with neuropathic pain, while nociplastic pain was linked to longer pain duration and sleep disturbance. Nociceptive pain was inversely associated with CHIK-DAS and medication security risk.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-phenotypes-and-social-determinants-of-health-in-chronic-chikungunya-arthritis-a-cross-sectional-study/