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Stiffness, pain, and joint counts in chronic chikungunya disease: relevance to disability and quality of life

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Abstract

Introduction/Objectives

To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms.

Method

Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact.

Results

Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS global health perception was 68 ± 62 out of 100. Stiffness severity was correlated with tender joint counts (ρ = 0.46) and pain intensity (ρ = 0.40). All three measures were equally well correlated with the EuroQol-VAS global health perception. Pain and tender joints were better correlated with the HAQ-DI (ρ = 0.68 and ρ = 0.63), but stiffness was more strongly correlated with several quality of life domains, including mobility. Swollen joints were a poor predictor of outcomes.

Conclusions

Musculoskeletal stiffness following chikungunya infection is distinct from arthralgia. It does not always occur in the same patients or with a corresponding intensity. Joint pain and stiffness may be independently associated with disability and quality of life assessments.

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Acknowledgments

The authors wish to acknowledge the contributions of Giulia Calusi to the statistical analysis of these data, and Serena Halls for kindly sharing and agreeing to our use of the questionnaire for assessment of musculoskeletal stiffness.

Funding

This work is supported by a Pilot award from the Rheumatology Research Foundation and the NIH (National Center for Advancing Translational Sciences grants UL1-TR-001876 and KL2-TR-001877).

Author information

Authors and Affiliations

  1. Evotec ID, Bioaster Building, 40 Avenue Tony Garnier, 69007, Lyon, France

    Hugh Watson

  2. Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark

    Hugh Watson

  3. Microbiology, Immunology and Tropical Medicine, George Washington School of Medicine and Health Sciences, Washington, DC, USA

    Sarah R. Tritsch & Aileen Y. Chang

  4. Allied Research Society LLC, Barranquilla, Atlántico, Colombia

    Liliana Encinales

  5. Clinica de La Costa Ltda, Barranquilla, Atlántico, Colombia

    Andres Cadena

  6. Biomelab, Barranquilla, Atlántico, Colombia

    Carlos Cure

  7. Universidad El Bosque, Bogotá, Colombia

    Alexandra Porras Ramirez & Alejandro Rico Mendoza

Authors
  1. Hugh Watson
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  2. Sarah R. Tritsch
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  3. Liliana Encinales
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  4. Andres Cadena
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  7. Alejandro Rico Mendoza
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  8. Aileen Y. Chang
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Corresponding author

Correspondence to Hugh Watson.

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Ethical standards

This study (IRB#121611, Trans#28283) was approved by the ethics committee of the Clinica de La Costa Ltda. and the George Washington University Committee on Human Research and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Watson, H., Tritsch, S.R., Encinales, L. et al. Stiffness, pain, and joint counts in chronic chikungunya disease: relevance to disability and quality of life. Clin Rheumatol 39, 1679–1686 (2020). https://doi.org/10.1007/s10067-019-04919-1

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  • DOI: https://doi.org/10.1007/s10067-019-04919-1

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