Background/Purpose: It is well known that viral infections can trigger autoimmune rheumatic diseases. In 2,014 there was an outbreak of Chikungunya (CHIK) virus infection in Venezuela. A majority of infected patients develop a flare of self-limited acute polyarthritis followed by complete remission. Some patients continue to experience subacute and chronic joint inflammatory symptoms. However, it is not well known how many of those patients evolve into a well-defined chronic rheumatic condition. The aim of this study was to examine how many patients with post-CHIK chronic inflammatory rheumatism (CHIK-CIR) evolve into a definite chronic rheumatic disease.

Methods: One hundred and sixty-eight patients seen during the period between 2,014 and 2,016 were included in this study. Post-CHIK CIR criteria were: 1. A triad of arthritis, fever and rash in presence of musculoskeletal manifestations (N=50, 29.76%) or 2. Musculoskeletal manifestations with or without the whole triad plus a positive IgM o IgG CHIK serology ELISA test (N=118, 70.23%). In both cases persistence of the symptoms for more than three months was required. The diagnosis for a definite rheumatic disease was done following the corresponding American College of Rheumatology (ACR) criteria. Statistical analysis was done by Chi-square and the Exact Fisher´s test. P-values of < 0.001 were considered statistically significant. All patients signed an informed consent.

Results: A positive CHIK serology test was tested and resulted positive in 70.23% of patients (IgM and IgG in 44 and 117 patients, respectively). Rheumatoid factor (RF) was positive in 24.13% and anti-citrullinated peptide antibodies (ACPA) in 25.66% of the patients. Of the total population (168 patients) with post-CHIK-CIR, 89.29% were female, mean age was 55.33 ± 12.72 years, and mean disease follow-up was 73.9±15.6 months. Forty patients (23.80%) had family history for autoimmunity. Thirty patients (17.85%) evolved into the following definite rheumatic diseases: rheumatoid arthritis (12.50%), psoriatic arthritis (2.38%), spondyloarthritis (1.79%) and systemic lupus erythematosus (0.60%). There was a statistically significant association between positivity of RF, ACPA or both with development of the de novo rheumatic diseases (P < 0.0001 in each case). Other variables studied no related with development of de novo rheumatic disease were: IgM and IgG serology titers, presence of tenosynovitis and elevation of acute phase reactants.

Conclusion: CHIK virus infection can trigger a chronic autoimmune rheumatic disease, predominantly rheumatoid arthritis. Risk factors are the appearance of either RF or ACPA, or both.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatic-conditions-appearing-de-novo-after-infection-with-chikungunya-virus-in-venezuelan-patients/