Chikungunya Virus Infection: An Update on Joint Manifestations and Management

Abstract

A bbreviations: CHIKV, Ckikungunya virus; CIR, chronic inflammatory rheumatism . Ci t ation: Krutikov M, Ma nson J. Chikungunya Virus In fection: An Update on Joint Ma nifestations and Ma nagem ent . Ra m bam Ma imonides Med J 2 016;7 (4):e0033. doi:1 0.5041/RMMJ.1 0260 Review Copy r ight: © 2 016 Krutikov and Ma nson. This is an open-access article. All its content, except where otherwise noted, is dist ributed under the terms of t he Creative Com mons Attribution License (http://creativecom mons.org/licenses/by/3.0), w h ich permits unrestricted u se, distribution, a nd reproduction in any m edium, prov ided the original work is properly cit ed. Ram bam Maim onides Med J | www.rmmj.org.il 1 October 2016  Volum e 7  Issue 4  e0033 ABST RACT The adv ent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne v iruses like Chikungunya. This infection has become increasingly prevalent in the last 1 0 years across the Indian Ocean and has been brought to media at tention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air trav el, allowing infected individuals to transport the v irus to pre -v iously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA. The duration and ex tent of the arthritis seen peri-and post infection has become a topic of academic interest. Although published data are largely observational, there has been a definite increase in original research focusing on this. Sy mptoms can persist for years, particularly in older patients with p re-existing medical conditions. The etiology is still not fully understood, but v iral persistence and immune activation within sy novial fluid have been shown in mouse models. There have been no prospective clinical trials of treatment in humans; however, animal trials are in process. The mainstay of treatment remains anti-inflammatories and steroids where necessary . The clinical presentation seems to mimic common rheumatological conditions like rheumatoid arthritis; therefore recent recommendations suggest the use disease-modifying agents as a common practice for the specific syndrome. This review uses recent published data and draws on our own clinical ex perience to provide an ov erview of joint complications of Chikunguny a infection.