Objectives: To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. Methods: From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. Results: Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95–2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01–1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48–1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). Conclusions: These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
Bibliographical noteFunding Information:
This work was supported by the Brazilian National Council for Scientific and Technological Development (Grants 400830/2013-2 and 440891/2016-7 to GSR, and scholarships to LBT, UK, MGR and GSR); the Bahia Foundation for Research Support ( PET0026/2013 , APP0044/2016 and PET0022/2016 to GSR, and scholarship to MMOS); the Coordination for the Improvement of Higher Education Personnel, Brazilian Ministry of Education ( 88881.130749/2016-01 to GSR and scholarship to MK); the Department of Science and Technology, Secretariat of Science, Technology and Strategic Inputs, Brazilian Ministry of Health ; the Federal University of Bahia ; the Oswaldo Cruz Foundation ; and the REPLICK (Clinical and Applied Research in Chikungunya). The funding sources had no role in study design; collection, analysis and interpretation of data; writing of the paper; and the decision to submit the article for publication.
© 2021 The Author(s)
- Chikungunya virus
- Chronic arthralgia
- Risk factor