Incidence of articular pain and arthritis after chikungunya fever in the Americas: A systematic review of the literature and meta-analysis

Abstract

Objective: To estimate the incidence of chronic articular symptoms after chikungunya virus infection of patients from the American continent.

Methods: We performed a systematic review of the literature using the MEDLINE, Web of Science and Scopus databases. We included only cohort studies conducted in the American continent reporting the incidence of chronic articular symptoms after chikungunya virus acute infection. The quality of the selected studies was evaluated through the Newcastle-Ottawa Scale for non-randomized studies and relevant data were extracted. The pooled incidence of post-chikungunya chronic symptoms was estimated using a random-effect model meta-analysis. Heterogeneity was assessed by Q of Cochrane and its P-value, Tau² and I². Subgroup analysis was performed, and studies were stratified by quality, sample size, region, country, period of follow-up and study design.

Results: Up to February 24, 2018, a total of 1115 potentially relevant studies were identified through our search strategy. After exclusion of 226 duplicates and 845 irrelevant studies, we retrieved 41 articles for full-text appreciation, from which 18 studies met our inclusion criteria and were included in this systematic review. Our meta-analysis suggests that 52% of the patients infected with the chikungunya virus will present chronic articular symptoms, although a high heterogeneity between studies was also found (I² = 94%).

Conclusion: Fifty-two percent of chikungunya infected patients in the American continent are expected to develop the chronic stage of the disease. Chikungunya fever needs to be dealt as a major world health problem.

Keywords: Chikungunya fever; Chikungunya virus; Post-infectious arthritis; Virus arthritis.