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Chikungunya symptoms may mimic seronegative RA
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The Chikungunya virus can present symptoms similar to those of rheumatoid arthritis, and physicians evaluating suspected new rheumatoid arthritis in patients should ask patients about their travel history, according to newly published research.
Researchers studied clinical data from 10 American patients infected with Chikungunya virus (CHIKV) nearly simultaneously after visiting Haiti in June 2014. All reported getting mosquito bites while in Haiti. Most presented with acute fever, rash, headache, arthritis, with no differences between younger and older patients (range: 18 to 57 years).
Deborah J. Lenschow
Patients were examined using the Washington University Arthritis and Rheumatology-Tissue Procurement Facility protocol, which included American College of Rheumatology (ACR) / European League Against Rheumatism (EULAR) criteria. According to the researchers, all patients met the ACR/EULAR 2010 criteria for rheumatoid arthritis (RA) had the researchers not known about their travel history through their first patient, a nurse.
“The biggest lesson we learned was that if she wasn’t a health care worker and wasn’t aware of the Chikungunya outbreak and just came back with this terrible illness, all of these patients met ACR criteria for having seronegative RA,” study author, Deborah J. Lenschow, MD, PhD, said in an interview with Healio.com/Rheumatology. “It was critical that we had her travel history.”
The patient proposed study of the other members in her group and two other groups from the St. Louis area who traveled to Haiti around the same time.
Eight of the 10 patients who agreed to participate had persistent arthritis and reported widespread myalgias, arthralgias and symmetric polyarthritis. Joint pain and stiffness was reported at least 8 weeks after initial infection, although some reported gradual improvement. In some cases, patients missed work due to the severity of symptoms, and two chronic patients had difficulty with ambulation due to lower-extremity pain. The use of NSAIDs was reported to be minimally effective, according to the researchers.
A laboratory panel included a complete blood count and comprehensive metabolic panel.
Three patients had positive anti-nuclear antibodies and one had elevated C-reactive protein, but none were positive for rheumatoid factor or anti-citrullinated peptide antibodies, and none had familial history of rheumatic disease.
Peripheral blood mononuclear cells (PBMCs) were collected from CHIKV patients, six newly diagnosed RA patients with no recent travel history and from healthy controls. PBMCs were analyzed using mass cytometry. Analysis suggested that lymphocyte phenotypes in patients with CHIKV and RA may be similar and differentiated from healthy control individuals, but more study is needed to confirm validity.
The virus is spreading, and so should awareness, according to Lenschow. Although Florida is the only place the virus has been acquired locally, Lenschow said the carrier species of mosquitoes are also present in Texas along the Gulf of Mexico. Travel to either of those areas should also prompt physicians to consider CHIKV.
Mutations may allow other species of mosquitoes prevalent across the U.S. to transmit the disease, according to Lenschow.
“If the virus circulating around the Caribbean Islands acquires a mutation, the odds are greater that we could see much more significant local transmission,” she said. “It doesn’t take long once there is a mutation. I anticipate it will become more widespread.”
Identifying biomarkers will be important moving forward, Lenschow said. – by Shirley Pulawski
Disclosure: The authors have no relevant financial disclosures.
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