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25-03-2012 | Immunology | Article

Arthralgia help necessary for patients after CHIKV infection


Free abstract

MedWire News: Patients with rheumatic manifestations following infection with the chikungunya virus (CHIKV) may require support with symptoms and the associated reduction in quality of life (QoL) while they return to good health, research suggests.

The study, published in Rheumatology, indicates that older individuals, those with comorbidity, and patients who are acutely ill with CHIKV infection for more than 15 days are at highest risk for slow recovery from sequelae.

CHIKV infection is an alphavirus transmitted through the Aedes mosquitoes in Africa and Asia, causing acute febrile disease, followed by a prolonged period of arthralgic disease, explain Elisabeth Couturier (Institut de Veille Sanitaire, Saint-Maurice, France) and co-workers.

The team determined the frequency of rheumatic manifestations in 509 French patients who were infected during an outbreak in the Indian Ocean islands in 2005, and were followed up for 23.4 months.

Overall, 391 of the patients participated in the study; they were aged an average of 50.2 years, 53.5% were female, and 60% had at least one comorbidity. Almost all patients experienced fever (96%), arthralgia (99%), joint stiffness (93%), and joint swelling (74%). The acute stage lasted less than 8 days for 50% of the patients and for 8-30 days in the remainder.

At follow up, an average of 22.9 months after symptom onset, 45% of the patients considered themselves to have recovered, and 55% continued to experience arthralgia. The patients had a mean duration of 6-9 months illness, with a probability of 0.39 for the return of health after 1 year. Patients who had not fully recovered were older than recovered patients, had more comorbidities, and had experienced a longer acute stage with joint swelling.

A significant proportion (72%) of patients reported relapses of arthralgia (an average of four episodes), almost always affecting the same joints as the original illness.

In multivariate analysis, the probability of recovery significantly fell with increasing age, with a hazard ratio (HR) of 0.51 for patients aged 30-49 years and 0.37 for those aged 50-69 years compared with patients aged less than 30 years. Recovery was also less likely for those who had an acute stage of 15 days or longer (HR=0.51).

Although recovered patients had significantly higher QoL than unrecovered patients, 25% of recovered patients continued to have low values, although Short Form 36 (SF-36) values did not significantly differ between recovered patients and a healthy age- and gender-matched population. Unrecovered patients experienced significant deficits in physical and mental functioning, as well as smaller reductions in social domain scores.

Poorer QoL results were significantly predicted by lack of recovery, comorbidity, and greater acute stage duration, Couturier et al note.

"Medical follow-up of CHIKV-infected patients until full recovery is important in order to ensure a return to normal perceived health and QoL," the team recommends.

"Paying attention to comorbidity may help anticipate a potential great deterioration in their QoL."

Recognizing that patients may benefit from help for anxiety and depression over continuing symptoms, the researchers add: "Patients can be informed that return to normal will progressively occur in most cases and could benefit from sharing of information about the possible chronic symptoms and the unpredictable course of the disease."

By Lynda Williams

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