Brief report: the disability of chronic chikungunya arthritis

  • J. Kennedy Amaral
  • Joshua B. Bilsborrow
  • Robert T. SchoenEmail author
Brief Report


In 50% of patients, chikungunya fever (CHIKF) is followed by arthritic pain that is often chronic, painful, and disabling. To better define the spectrum of pain and disability in chronic CHIK arthritis (CCA), we evaluated 35 consecutive CCA patients seen in a Brazilian rheumatology clinic, using a pain Visual Analog Scale and the Health Assessment Questionnaire Disability Index. In our patients, pain and disability levels were of the same magnitude as are seen in other serious rheumatic diseases. The mean score for 19 patients with moderate disability was 1.42± 0.20 (median 1.37). The median HAQ-DI score for the entire group was 1.25. These findings underscore the morbidity imposed by CCA and the urgent need for improvements in management.


Chronic chikungunya arthritis Disability Health Assessment Questionnaire Disability Index (HAQ-DI) Visual Analog Scale (VAS) 


Compliance with ethical standards




  1. 1.
    Silva LA, Dermody TS (2017) Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies. J Clin Invest 127(3):737–749. CrossRefPubMedGoogle Scholar
  2. 2.
    Ferreira-Sarmiento S, Lastra-Terán KP, De la Rosa D, Viasus D (2015) Severe chikungunya virus infection. Salud Uninorte 31(3):631–641. CrossRefGoogle Scholar
  3. 3.
    Schilte C, Staikovsky F, Couderc T, Madec Y, Carpentier F, Kassab S, Albert ML, Lecuit M, Michault A (2013) Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis 7(3):e2137. CrossRefPubMedGoogle Scholar
  4. 4.
    Yactoyo S, Staples JE, Millot V, Cibrelus L, Pardo PR (2016) Epidemiology of chikungunya in the Americas. J Infect Dis 214(5):441–445. CrossRefGoogle Scholar
  5. 5.
    Simon F, Javelle E, Cabie A, Bouquillard E, Troisgros O, Gentile G, Leparc-Goffart I, Hoen B, Gandjbakhch F, Rene-Corail P, Franco JM, Caumes E, Combe B, Poiraudeau S, Gane-Troplent F, Djossou F, Schaerverbeke T, Criquet-Hayot A, Carrere P, Malvy D, Gaillard P, Wendling D, Société de pathologie infectieuse de langue francaise (2015) French guidelines for the management of chikungunya (acute and persistent presentations). November 2014. Med Mal Infect 45(7):243–263. CrossRefPubMedGoogle Scholar
  6. 6.
    Chang AY, Martins KA, Encinales L, Reid SP, Acuña M, Encinales C et al (2018) Chikungunya arthritis mechanisms in the Americas. Arthritis Rheum 70(4):585–593. CrossRefGoogle Scholar
  7. 7.
    Amaral JK, Sutaria R, Schoen RT (2018) Treatment of chronic chikungunya arthritis with methotrexate: a systematic review. Arthritis Care Res 70:1501–1508. CrossRefGoogle Scholar
  8. 8.
    Marimoutou C, Ferraro J, Javelle E, Deparis X, Simon F (2015) Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later. Clin Microbiol Infect 21(7):688–693. CrossRefPubMedGoogle Scholar
  9. 9.
    Ramachandran V, Malaisamy M, Ponnaiah M, Kaliaperuaml K, Vadivoo S, Gupte MD (2012) Impact of chikungunya on health related quality of life Chennai, South India. PLoS One 7(12):e51519. CrossRefPubMedGoogle Scholar
  10. 10.
    Soumahoro M, Gérardin P, Boëlle P, Perrau J, Fianu A, Pouchot J et al (2009) Impact of chikungunya virus infection on health status and quality of life: a retrospective cohort study. PLoS One 4(11):e7800. CrossRefPubMedGoogle Scholar
  11. 11.
    Amaral JK, Schoen RT (2018) Chikungunya in Brazil: rheumatologists on the front line. J Rheumatol 45(10):1491–1492. CrossRefPubMedGoogle Scholar
  12. 12.
    Bruce B, Fries JF (2003) The Stanford health assessment questionnaire (HAQ): a review of its history, issues, progress, and documentation. J Rheumatol 30(1):167–178PubMedGoogle Scholar
  13. 13.
    Cunha-Miranda L, Barcelos F, Miguel C, Silva C, Santos H, Fernandes S, Borges J, Trinca R, Vicente V, Aguiar P (2014) AB1071 the use of visual analogue scale in rheumatic disease: validation of an electronic version: table 1. Ann Rheum Dis 73(Suppl 2):1155.2–1155. CrossRefGoogle Scholar
  14. 14.
    Holm MB, Rogers JC, Kwoh CK (1998) Predictors of functional disability in patients with rheumatoid arthritis. Arthritis Care Res 11(5):346–355. CrossRefPubMedGoogle Scholar
  15. 15.
    Jankowska-Polańska B, Polański J (2014) Review methods of evaluation of the quality of life in rheumatic diseases. Reumatologia/Rheumatology 1:69–76. CrossRefGoogle Scholar
  16. 16.
    Ganu MA, Ganu AS (2011) Post-chikungunya chronic arthritis—our experience with DMARDs over two year follow up. J Assoc Physicians India 59:83–86PubMedGoogle Scholar
  17. 17.
    Bouquillard E, Fianu A, Bangil M, Charlette N, Ribéra A, Michault A, Favier F, Simon F, Flipo RM (2018) Rheumatic manifestations associated with chikungunya virus infection: a study of 307 patients with 32-month follow-up (RHUMATOCHIK study). Joint Bone Spine 85(2):207–210CrossRefPubMedGoogle Scholar
  18. 18.
    Pandya S (2008) Methotrexate and hydroxychloroquine combination therapy in chronic chikungunya arthritis: a 16 week study. Indian J Rheumatol 3(3):93–97. CrossRefGoogle Scholar
  19. 19.
    Blettery M, Brunier L, Polomat K, Moinet F, Deligny C, Arfi S, Jean-Baptiste G, De Bandt M (2016) Brief report: management of chronic post-chikungunya rheumatic disease: the martinican experience. Arthritis Rheum 68(11):2817–2824.
  20. 20.
    Ravindran V, Alias G (2016) Efficacy of combination DMARD therapy vs. hydroxychloroquine monotherapy in chronic persistent chikungunya arthritis: a 24-week randomized controlled open label study. Clin Rheumatol 36(6):1335–1340. CrossRefPubMedGoogle Scholar
  21. 21.
    Schoenfeld-Smith K, Petroski GF, Hewett JE, Johnson, JC, Wright GE, Smarr KL, Walker SE, Parker JC (1996) A biopsychosocial model of disability in rheumatoid arthritis. Arthritis Care Res 9(5):368–375Google Scholar
  22. 22.
    Carmona L (2001) The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 60(11):1040–1045. CrossRefPubMedGoogle Scholar
  23. 23.
    Wysocka-Skurska I, Sierakowska M, Kułak W (2016) Evaluation of quality of life in chronic, progressing rheumatic diseases based on the example of osteoarthritis and rheumatoid arthritis. Clin Interv Aging 11:1741–1750. CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of Infectious Diseases and Tropical MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  2. 2.Section of Rheumatology, Allergy and Clinical ImmunologyYale University School of MedicineNew HavenUSA

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