Background/Purpose: Chikungunya virus is an alphavirus, belonging to the Togaviridae family. It is transmitted by several species of mosquitoes, with Aedes species being main culprit. The symptoms generally start 4–7 days after the bite. Acute infection lasts for 1–10 days and is characterized by abrupt onset of fever, headache, fatigue, nausea, vomiting, rash, myalgia, and severe arthralgia. Painful polyarthralgia is the typical symptom causing serious economic and social impacts on both the individuals and the affected communities. This study was meant to look at frequency of patients coming with persistent arthritis and to share our experience in treating it.

Methods: This cross-sectional study was conducted in Liaquat National Hospital, Karachi. It comprised of collected data of patients who presented with arthritis and positive chikungunya serology. Data was collected on a pre-designed porforma. It was analysed by using the Statistical package for social science (SPSS)version 20.0. Response to treatment was characterized according to visual analogue scale (VAS) taken at baseline, 2 weeks and 4 weeks. Stratification was done according to age, gender, duration of fever, number of joints, duration of symptoms, laboratory parameters and co-morbidities. Post stratification Chi square test was applied taking p value ≤ 0.05 as significant.

Results: A total of 112 patients were included in the study, of which 31 (27.7 %) were male and 81 (72.3 %) were female. Symmetrical arthritis was reported in 85 (75.9%) patients, while asymmetrical arthritis was seen in 27 (24.1%) patients. 75 (66.9%) had polyarthralgia involving small, medium and large joints (P=0.000). Morning stiffness was reported in 68 (60.7%) of patients (P=0.000). ESR was raised in 78(69.6%) patients (P=0.000), while raised CRP was seen in 69(61.6%) patients (P=0.001).
37 (33%) patients were given NSAIDs, 66 (58.9%) received steroids, and other forms of analgesics were prescribed to 9 (8%) patients. In nearly half of the patients, i.e. 62 (55.4%) partial response was seen, 13 (11.6%) showed complete response, while 37 (33%) had persistent arthralgia. Out of 66 patients treated with steroids, 48 (72.7%) showed partial response (VAS score <5), 13 (19.7%) showed complete response (VAS score 0), while 5 (7.57%) patients had persistent arthralgia (VAS score >5) (P=0.000).
Out of the 5 patients having persistent arthralgia in the steroid group, 3 patients later after 6 months of follow-up on repeating had anti-CCP positive, while 2 were negative. They were treated as inflammatory arthritis with DMARDS.

Conclusion: This study shows post-chikungunya arthritis to be a great mimicker of inflammatory arthritis. This study brought us to the conclusion that a single dose of methylprednisolone was helpful in successfully treating patients experiencing post-chikungunya arthritis and this did not have a significant impact on patients monetary wise. With all this said further research needs to be conducted on establishing the link between chikungunya virus and development of inflammatory arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/to-study-the-frequency-of-persistent-arthritis-in-patients-with-chikungunya-fever-in-a-tertiary-health-care-center/