Background/Purpose: There is no data in the literature about chikungunya fever (chik) and SLE. Martinique (French West Indies) experienced for the first time an outbreak of chik during the year 2014 that was an opportunity to study the relation between SLE and this viral infection.

Methods: The main objective was to describe the evolution of Chik patients with SLE. We also searched to know (1) if chik could modify SLE disease activity, (2) the role of SLE treatments, particularly immunosuppressive drugs, during the Chik episode. We perform a retrospective, monocentric, systematic evaluation of all SLE patients (fulfilling 1997 ACR criteria) followed in the internal medicine and rheumatology unit of the University hospital, between january 2014 and may 2015, assessing (1) SLE activity, (2) the presence of signs compatible with a chik episode. A systematic viral serology was prescribed with their usual biological follow up for all patients. Chik severity was considered if an encephalopathy, myocarditis, hepatitis, or multiorgan failure was present.

Results:

167 patients were screened for chik by serology, and we had a result for 110 in may 2015. 56 were included with a positive serology for chik (female: 53; male: 3). Their basic parameters were: mean age at serology (46.5 years, range: 23-81), time since SLE diagnosis to chik episode (12.9 years), renal involvement (42.8%), treatment by immunosuppressant drugs (33.9%), hydroxychloroquine or chloroquine (86.8%), prednisone (64.8%), rituximab (n=3). Clinical signs compatible with a Chik episode were found in 82.6% of the patients with a positive serology. Four patients (7%), all younger than 55 years and one treated by mycophénolate, exhibit severe signs of chik including encephalopathy (n=4) associated with bullous cutaneous lesions (n=3), kidney involvement (n=2). One of these 4 patients who was not immunosuppressed, died in a context of systemic capillary leak syndrome and multiorgan failure. Six of 56 positive patients (10.7%) experienced a lupus flare, all after a symptomatic chik fever: 5/6 were on prednisone, 5/6 hydroxychloroquine and 3/6 (50%) immunosuppressive drugs.

Conclusion: SLE can lead to severe Chik infection and should be considered as a group at risk. Chik fever can probably induce SLE flare. Immunosuppressive drugs seem not influence the clinical picture of chik.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematosus-and-chikungunya-fever-interactions-during-the-2014-outbreak-in-martinique/