Chikungunya arthritis

Abstract

The chikungunya virus (CHIKV) infection epidemic has emerged as a significant public health concern in the last 10-15 years, especially in Asian and south American countries. However, with ever-expanding tourism and migration, cases have now been reported in north America and Europe. CHIKV infection predominantly causes musculoskeletal symptoms with a chronic polyarthritis which may resemble autoimmune inflammatory arthritis. CHIKV infection should always be suspected in a returning traveller presenting with fever, skin rash and arthralgia. Though first reported in the last century, a series of epidemics since 2004 have substantially improved our knowledge. There has also been a significant increase in our understanding of the immunopathogenesis of chikungunya infection. This knowledge is being used in the development of new treatment strategies and preventive measures. In this narrative review, we discuss some of the recent advances in the epidemiology, immunopathogenesis, and management of CHIKV arthritis.

Keywords: Chikungunya infection; DMARDs; chronic arthritis; chronic inflammatory rheumatism; methotrexate; viral arthritis.

Fig 1.

Countries with the presence of chikungunya infection. Does not include countries or territories where only imported cases have been documented. Reproduced with permission from Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). Geographic distribution: where has chikungunya virus been found? Atlanta: CDC, 2018. www.cdc.gov/chikungunya/geo/index.html [Accessed on 15 January 2019].