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Chikungunya: What Every Rheumatologist Needs to Know

Dany V. Thekkemuriyil, MD  |  Issue: November 2014  |  

There has been only anecdotal evidence for the use of disease-modifying antirheumatic drugs in the chronic arthritic phase. A single, randomized, controlled study, comparing chloroquine with NSAIDs (meloxicam), failed to demonstrate any advantage of chloroquine over meloxicam.36

Active research is underway to develop a better vaccine and treatments for Chikungunya infection. Currently, prevention consists of minimizing mosquito exposure.

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Conclusion

Chikungunya continues to spread to different geographic areas and is a major threat with its ability to rapidly infect a large population. The debilitating severe chronic arthritis, which can present in a similar fashion to RA, is a serious concern for rheumatologists. In the U.S., the vectors transmitting dengue virus are only seen in the southern and southeastern states, but it has been demonstrated in the lab that it does not take long for viral mutation and mosquito adaptability to occur. Better understanding of the pathophysiogenesis is needed for developing treatment and preventive strategies. More randomized, controlled studies are needed to guide treatment approaches.

Dany V. Thekkemuriyil, MD, is a rheumatology fellow at Washington University in St. Louis. He saw Chikungunya during the outbreak in India.

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Chikungunya—Things to Note

  • Acute presentation is characterized by high-grade fevers, joint pain, rash.
  • Chronic persistent arthritis lasting months to years, which can present similar to RA.
  • Travel history and history of sick contacts is important.
  • Report suspected cases to the state or local health department.
  • Laboratory diagnosis: Serology to detect IgMif ≥4 days, IgG >2 weeks since onset (CDC). RT-PCR to detect viral RNA if in first week of illness.
  • Supportive treatment: fluids, analgesics, NSAIDs.

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