COMMENTARY

Rheumatology Advances to Know From 2015

Kevin Deane, MD, PhD

Disclosures

December 23, 2015

In This Article

An Update on Chikungunya and Uric Acid

Infection with the mosquito-transmitted chikungunya virus (CHIKV) leads to a clinical syndrome consisting of fever, rash, and myalgia, as well as abrupt onset of arthralgia and frank arthritis.[42] These symptoms typically resolve within 1-2 weeks. However in some individuals, arthritic symptoms can last for up to 3 years, mimicking RA in clinical presentation. In some cases, erosive disease has been identified.[43]

From 2014 to 2015, most cases of CHIKV in the United States were due to infection that occurred in the Caribbean region, including Haiti, Jamaica, and Cuba. However, endemic areas are expanding, and endogenously acquired CHIKV has been reported in Florida,[44] and it is likely that an increasing number of cases will be seen in the United States that were acquired in foreign sites as well as within the United States. Rheumatologists will therefore need to be aware of CHIKV as a potential cause for arthritis by assessing the appropriate travel history to CHIKV-endemic regions and recognizing clinical features that may indicate infection with this virus.

Currently, testing for CHIKV is only available through the Centers for Disease Control and Prevention, but as this disease evolves, more widespread testing may soon be available.

Uric Acid: Impact Beyond Joint Disease

Rheumatologists are very familiar with the articular effects of uric acid.[45] However, there is a growing awareness of how uric acid may be associated with (and perhaps causative of) other diseases, including impaired renal function, hypertension, and atherosclerosis.[46,47] Some evidence suggests that uric acid could mediate injury to these other systems through local tissue oxidation and inflammation, but the precise mechanisms linking uric acid to diseases outside of the joints are just beginning to be understood. As such, although this is an exciting area of research, we will need to know more before uric acid-lowering therapies are widely instituted for diseases beyond arthritis.

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