CHIKV and RA

“Chikungunya infection is not likely to be confused with rheumatoid arthritis for the majority of cases that are self-limited. In these cases, symptoms come on suddenly and are gone quickly,” said Layden.


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In cases where joint symptoms last long after the acute phase of the infection, CHIKV can be a good mimic of RA. CHIKV causes pain and swelling in distal joints of the hands, wrists, feet, and ankles. As with RA, there may be morning stiffness, and the distribution is symmetrical. These symptoms may meet the American College of Rheumatology (ACR) criteria for seronegative RA.1,4

CHIKV may also have some overlapping immunologic features. A 2015 study, published in Arthritis & Rheumatology, found that eight of 10 confirmed CHIKV patients met ACR criteria for seronegative RA and developed very similar peripheral T cell phenotypes. The study concluded that rheumatologists need to be aware of these similarities and consider CHIKV when evaluating patients referred for RA.4

Final Thoughts

 “The most important thing for primary care providers is to be aware of this emerging viral infection. To diagnose chikungunya, you need a high index of suspicion. Care givers should consider testing for anyone with sudden onset of the symptoms who has traveled in an area where the infection is common,” said Layden.

“Primary caregivers should also warn patients who may be traveling to the Caribbean or to Central or South America on vacation. These mosquitos are daytime biters. Use DEET or a picaridin-containing mosquito repellent during the day in these areas. Patients who come down with the infection should be warned that the arthritis symptoms could be severe and long lasting,” said Hayden.

Medically reviewed by: Pat F. Bass III, MD, MS, MPH       

References

1.     The Rheumatologist, Chikungunya: What Every Rheumatologist Needs to Know.

2.     CDC, Chikungunya Information for healthcare providers.

3.     CDC. 2015 provisional data for the United States.  

4.      Milner JJ. Arthritis Rheum. 2015; DOI: 10.1002/art.39027