FRI0438 POST-CHIKUNGUNYA CHRONIC ARTHRITIS - SHARING OF BANGLADESH EXPERIENCE OVER ONE YEAR FOLLOW UP OF 60 PATIENTS
Authors: S. Hossain, M. Choudhury, M. A. Islam, M. M. Hassan, S. Yeasmin, F. Hossain
Journal: Annals of the Rheumatic Diseases (2020)

Background: Chikungunya virus (CHIKV) infection is an emerging disease which is responsible for several epidemics around the world 1 . Systematic review and meta-analysis had shown that approximately 25% of cases of Chikungunya(CHIK) would develop CHIK-Chronic Inflammatory Rheumatism and 14% would develop persistent arthritis (or spondylitis) 2 . Objectives: To describe the frequency of the clinical patterns of chronic arthritis &amp; to characterize the clinical symptoms in a Bangladeshi cohort of CHIK patients 12months post-infection. Methods: In 2017, a Chikungunya outbreak occurred in Dhaka, Bangladesh, during which a prospective cohort of CHIK patients with confirmed diagnosis was constituted. A longitudinal follow up of 60 patients from an initial cohort of 142 patients, attending the out-patient department of Rheumatology, BSMMU, was done. Patients having arthritis/ arthralgia or both lasting more than 3 months were considered as chronic cases. Their baseline and follow-up symptoms at 3m, 6m and 12months were evaluated. Functional status was assessed with the Bengali Version Health Assessment Questionnaire (HAQ). Results: Of the initial 142 patients enrolled in the study, 135(95.1%) had CHIKV-IgM and 29(20.4%) had IgG positive. Patients that followed up in-person were predominantly adult (age 43.73 ± 11.09 years) and female 34 (56.7%). The majority of the patients 35 (58.3%) had undifferentiated arthritis. After three months, 8 (16.3%) had oligoarthralgia, 26 (53.1%) had polyarthralgia and 8 (16.3%) had polyarthralgia with oligoarthritis. At the end of one year, 13 (21.7%) patients underwent complete remission. Among the 47 patients, 21 had joint involvement where 11(52.4%) had polyarthralgia, 5(23.8%) had polyarthralgia with oligoarthritis, 5 (23%) had oligoarthralgia and 4 (19%) had monoarthralgia. Among the 47 patients, mild, moderate and severe functional disability was present in 89.4%, 6.4% and 4.3% patients respectively. Conclusion: After one year of follow up, one-third of the patients remained symptomatic. Polyarthralgia was the predominant clinical feature. Mild functional disability was also observed in a significant number of patients. References: [1]Ali Ou Alla S, Combe B. Arthritis after infection with Chikungunya virus. Best Pract Res Clin Rheumatol. 2011;25(3):337-46. [2]Rodríguez-Morales AJ et al. Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Arthritis. Care. Res . 68(12), 1849-1858 (2016). Table 1. Socio-demographic and clinical pattern of patients with Chronic CHK arthritis (n=60) Variables n(%) Age (in years) Mean ±SD 43.73 ±11.1 Sex Female 34 (56.7) Male 26 (43.3) First joint involvement Generalized 34 (56.7) Ankle 12 (20.0) Knee 6 (10.0) Wrist 5 (8.3) Others (MTP, shoulder, neck and axial plane) 3 (5.0) Clinical pattern Undifferentiated 35(58.3) Spondyloarthritis 10 (16.7) Rheumatoid Arthritis 7 (11.7) Pre-existing Spondyloarthritis 6(10.2) Pre-existing Rheumatoid Arthritis 1(1.7) Pre-existing Osteo-arthritis Arthritis 1(1.7) Table 2. Joint involvement of patients with Chronic CHIK arthritis Joint characteristics 3 m (n=49) 6 m (n=36) 1yr (n=21) f(%) f(%) f(%) Type of involvement in persistent pain Joint only 33 (55.0) 28 (46.7) 20 (33.3) Both joint &amp; soft-tissue 16 (26.7) 8 (13.3) 1 (1.7) Joint involvement Monoarthralgia 1 (2.0) 5 (13.9) 4 (19.0) Oligoarthralgia 8 (16.3) 6 (16.7) 5 (23.0) Polyarthralgia 26 (53.1) 18 (50.0) 11 (52.4) Monoarthritis 1 (2.0) 0(0.0) 0(0.0) Oligoarthritis 6 (12.2) 3 (8.3) 0(0.0) Polyarthritis 7 (14.3) 9 (11.1) 1 (4.8) Oligoarthralgia &amp; monoarthritis 1 (2.0) 0 (0.0) 0 (0.0) Polyarthralgia &amp; monoarthritis 0 (0.0) 1 (2.8) 0 (0.0) Polyarthralgia &amp; oligoarthritis 8 (16.3) 4 (11.1) 5 (23.8) Polyarthralgia &amp; Polyarthritis 1 (2.0) 0 (0.0) 0 (0) Disclosure of Interests: None declared