Predictors of chronic joint pain after Chikungunya virus infection in the INOVACHIK prospective cohort study

Available online 8 October 2023, 105610

Author links open overlay panel, , , , , , , , , , , , , , AbstractBackground

Chikungunya can cause persistent chronic joint pain. Knowledge of the risk factors for disease progression is important for preventing and controlling complications. This study aimed to identify factors associated with chronic joint pain.

Methods

This prospective cohort study was conducted at a reference center in Rio de Janeiro. Men and women (aged ≥ 18 years) in the acute phase of Chikungunya were included. Clinical data and samples were collected over three months. Risk factors were evaluated using multivariate and logistic regression analyses.

Results

A total of 107 patients were followed up. The incidence rate of joint tenderness was 61.7%.Female sex (adjusted odds ratio [AOR] 3.24, 95% confidence interval [CI]:1.07–9.77), diarrhea (AOR 5.08, 95% CI:1.55–16.67), severe joint pain (AOR 4.26, 95% CI:1.06–17.06), and CHIKV real-time reverse transcription polymerase chain reaction positivity up to 5 days after the onset of symptoms in urine or saliva (AOR 4.56, 95% CI:1.41–14.77) were identified as predictors of persistent chronic pain.

Conclusions

In a predominantly female population, musculoskeletal symptoms are not the sole determinant of chronic pain, and careful evaluation of CHIKV detection in alternative body fluids (such as saliva and urine) during the early phase of the disease is warranted.

Section snippetsINTRODUCTION

Chikungunya (CHIK) is transmitted to humans through the bites of insects of the genus Aedes [1]. Historically, Chikungunya outbreaks have been confined to Africa, Asia, and the Indian subcontinent. Nevertheless, the virus has extended its reach over the last 20 years, resulting in significant outbreaks across the Americas, Europe, and the Asia-Pacific [2]. The emergence of the chikungunya virus in new territories frequently causes rapid and widespread outbreaks due to the population's absence

Data collection and patient recruitment

This prospective cohort study was conducted in Rio de Janeiro, Brazil. The Institutional Review Board reviewed and approved the study protocol (CAAE:06779019.0.0000.5262). Informed consent was obtained from all the participants. The patients were screened at a general febrile illness outpatient clinic.

Men and women aged ≥18 years who developed acute fever or arthralgia were enrolled. Detailed procedures of the INOVACHIK cohort study have been presented previously [15].Follow-up visits were

RESULTS

In total, 170 participants were screened between April and December 2019.Of these, 152 were enrolled in the study. Eighteen patients were excluded because of the absence of a confirmed chikungunya diagnosis. Among the patients with confirmed CHIKV infection, 107 (70.4%) completed the follow-up. The incidence of joint tenderness three months after symptoms onset was 61.7% (66/107) (Figure 1).

Of the 107 patients, 78 (72.9%) were female. Participants aged > 45 constituted more than half of the

DISCUSSION

In this well-established cohort of patients with confirmed CHIKV infection, we identified predictors of chronic pain among several factors present in the acute phase of the disease. In a predominantly female population, our analysis revealed that diarrhea, detection of CHIKV rRT-PCR in urine or saliva up to five days after illness onset, and severe pain were risk factors for developing chronic pain.

Our study demonstrated a high incidence of chronic joint tenderness three months after disease

AUTHORS’ CONTRIBUTION

EBM and GAC - Conceived and designed the experiments; EBM, MFBS, ICVM, APC, and GAC – data collection; EBM, MSBQ, and GAC - data analysis; FBN, CDSR, CCS, SAS, AAF, VCG, NRCF, and AMBF – performed molecular and serological experiments; EBM and GAC - wrote the paper; GAC, AMBF, and PB critically reviewed the manuscript; all authors read and approved the final manuscript.

FUNDING

This work was supported by INOVA FIOCRUZ [grant number: VPPCB-008-FIO-18-2-26].

Declaration of Competing Interest

The authors declare that they have no known competing financial interestsor personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors thank the patients for participating in this study and all employees of the Oswaldo Cruz Foundation.

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