Post Chikungunya Arthritis: A Real Diagnostic and Therapeutic Challenge
DOI:
https://doi.org/10.36570/jduhs.2020.1.890Keywords:
Chikungunya (CHIK), Arthritis, Disease modifying anti rheumatic drugs (DMARDs), Non-steroidal Antiinflammatory, drugs (NSAIDs), Disease activity score 28 (DAS 28)Abstract
Objective: To evaluate the response of disease modifying anti rheumatic drugs (DMARDs) on patients diagnosed with post chikungunya inflammatory arthritis attending outpatient department of Rheumatology, Jinnah Medical College Hospital, Karachi, Pakistan.
Methods: This prospective case series study was conducted at Rheumatology clinic of Jinnah Medical College Hospital in Karachi, Pakistan from January – June 2017 after a serious Chikungunya outbreak in November 2016. All patients diagnosed with Chikungunya viral fever who had joint pain refractory to non-steroidal anti-inflammatory drugs (NSAIDs) were evaluated. All eligible patients were given a trial of DMARDs along with systemic steroids (tapering) for 6 months. Clinical response and inflammatory burden were evaluated using the Disease Activity Score (DAS 28).
Results: Of 112 patients, more than half the population, 65/112 (58%) was in acute flare of disease at the beginning of study and interestingly not a single patient had high disease activity (DAS >5.1) at the end of 6 months. Patients who went into disease remission were able to lead a pain free life, while those with a relatively higher DAS28 were still struggling with the disease. The overall response to the therapy was eloquent. None of the patient remained in active flair by the end of 6 months. The mean DAS significantly decline at 6 months as compared to the baseline DAS (2.79 ±0.89 vs. 4.96 ±1.11 respectively, p-value <0.001)
Conclusion: Chikungunya virus can lead to symmetrical inflammatory arthritis that phenotypically mimics Rheumatoid arthritis but is not primarily Rheumatoid arthritis.
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Copyright (c) 2020 Mohammad Shariq Mukarram, Muhammad Ishaq Ghauri, Ashok Kumar, Amir Riaz, Syeda Urooj Riaz, Mohammad Mashood Iqbal
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