Symptoms of Chikungunya Virus Mimic Rheumatoid Arthritis

Alice Goodman

November 20, 2014

BOSTON — Rheumatologists need to be aware of possible Chikungunya virus diagnoses in patients who present with widespread joint pain, say experts here at the American College of Rheumatology 2014 Annual Meeting.

Although they were once only seen in Africa, cases of Chikungunya are starting to appear in the United States, and more than 1600 cases have been reported to date.

Once an acute attack resolves, many of these patients have persistent joint pain similar to that seen in patients with rheumatoid arthritis.

"If a patient has traveled to the Caribbean recently, that is a red flag. Currently, there are more than 780,000 cases in the Caribbean, and cases are emerging here, especially in Texas and Florida," said researcher Jonathan Miner, MD, from Washington University in St. Louis, Missouri.

"I had two patients come in with this last week," said Bonnie Bermas, MD, from Harvard Medical School in Boston, who was looking at Dr. Miner's poster.

The virus is spread by two types of mosquitoes: Aedes aegypti, found on the Gulf Coast near Florida and Texas; and Aedes albopictus, found all over the continental United States.

West Nile–Like Virus

"The virus can mutate in mosquitoes and spread just like the West Nile virus did a few years ago," Dr. Miner explained.

Acute attacks of Chikungunya virus last for 7 to 10 days and are characterized by a high fever, widespread rash, conjunctivitis in some patients, and joint pain in most. The virus is rarely fatal.

There is no known treatment for the virus. Acute attacks are managed with high-dose prescription nonsteroidal anti-inflammatory drugs (NSAIDs), but that is not always adequate, said Dr. Milner. "We need better treatments."

It's possible that the virus revs up the immune system to attack the joints.

His team evaluated the rheumatologic and immunologic features of 10 patients who contracted Chikungunya virus while traveling in Haiti. They compared these features with those from a cohort of patients with newly diagnosed and untreated rheumatoid arthritis.

After the acute infection resolved (6 to 8 weeks), eight of the 10 infected patients had arthritis symptoms identical to those of patients with seronegative rheumatoid arthritis, Dr. Miner reported.

The researchers used mass cytometry time of flight to analyze peripheral blood mononuclear cells in both cohorts, and found that all the patients had higher percentages of activated and effector CD4+ and CD8+ T-cells than healthy control subjects.

"The serum cytokine profiles of the Chikungunya patients and the seronegative rheumatoid arthritis patients were indistinguishable," Dr. Miner said.

In patients previously infected with Chikungunya, rheumatoid arthritis-like symptoms can persist for months or years, even though there is no detectable virus, he said.

To explain the similarity between the symptoms in the two groups, Dr. Miner said that "it's possible that the virus revs up the immune system to attack the joints."

"We are likely to see more and more patients with this virus," Dr. Bermas said. "Misdiagnosis of rheumatoid arthritis is possible. It is important for rheumatologists to be aware of the virus and its symptoms and to take a patient history of travel and exposure to avoid making the wrong diagnosis," she added.

Dr. Miner and Dr. Bermas have disclosed no relevant financial relationships.

American College of Rheumatology (ACR) 2014 Annual Meeting: Abstract L12. Presented November 18, 2014.


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