Successful Methotrexate Treatment of Chronic Chikungunya Arthritis

J. Kennedy Amaral, MD; Clifton O. Bingham, III, MD; Robert T. Schoen, MD, MBA


J Clin Rheumatol. 2020;26(3):119-124. 

In This Article


During 2017, 50 patients with chronic CHIK arthritis were seen in a rheumatology practice in the state of Pernambuco, in the northeast region of Brazil. Patients were included who had previous CHIKF (diagnosed by clinical and epidemiological criteria and confirmed by specific anti-CHIK immunoglobulin G–positive serology by enzyme-linked immunosorbent assay) and subsequently developed chronic CHIK arthritis, with rheumatic symptoms persisting for more than 12 weeks after onset of CHIKF. Patients were evaluated at a baseline visit and at follow-up at 4 and 8 weeks. Demographic features were obtained along with a medical and rheumatologic history that included any previous rheumatic disease preceding the development of CHIK as well as the details of the CHIK infection, timing, and sequelae. At the first visit, we documented antecedent and current musculoskeletal symptoms of chronic CHIK arthritis, including arthralgia, arthritis, low back pain, neck pain, morning stiffness, tenosynovitis, bursitis, fasciitis, and soft tissue pain. Prior treatment for CHIK-related musculoskeletal complaints arthritis was recorded. A comprehensive musculoskeletal examination was conducted by the rheumatologist, and affected joints were noted. To characterize clinical patterns of arthritis, we also used the American College of Rheumatology (ACR) classification criteria for the diagnosis RA and fibromyalgia (FM). Patients with inflammatory polyarthritis who did not meet these criteria were categorized as inflammatory undifferentiated polyarthritis. Undifferentiated polyarthritis was defined as the presence of inflammatory arthritis affecting more than 4 joints of greater than 6 weeks' duration in the absence of an alternative cause of inflammatory polyarthritis, including RA. Patients with or noninflammatory arthritis, including osteoarthritis, were classified as having musculoskeletal disorders.[20]

Patient symptomatic activity was assessed at each visit using a pain visual analog scale (VAS) (0–10), with higher values indicating more severe pain. Specific treatment initiated for musculoskeletal symptoms and dosages was recorded. At each visit, patients were monitored for fever, rash, neurological disease, or other symptoms suggestive of an exacerbation of CHIK infection. They were also assessed for evidence of or treatment toxicity such as rash, gastrointestinal symptoms, or other related problems.

Data in this study were collected between January and December 2017 from patients' medical records, using a standardized, structured questionnaire for data extraction. All identifying patient information was removed. This study was granted a waiver of consent approval, protocol 22390, by the Human Investigation Committee, Yale University, and approved by the ethics committee of the Faculdade de Medicina da Universidade do Cariri, approval 2.567.975. Descriptive statistical analyses were performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp, Armonk, NY).