Frequency of Chronic Joint Pain Following Chikungunya Virus Infection: A Colombian Cohort Study

Abstract

Objective: To estimate the frequency of chronic joint pain after infection with chikungunya virus in a Latin American cohort.

Methods: A cross-sectional follow-up of a prospective cohort of 500 patients from the Atlántico Department, Colombia who were clinically diagnosed as having chikungunya virus during the 2014-2015 epidemic was conducted. Baseline symptoms and follow-up symptoms at 20 months were evaluated in serologically confirmed cases.

Results: Among the 500 patients enrolled, 485 had serologically confirmed chikungunya virus and reported joint pain status. Patients were predominantly adults (mean ± SD age 49 ± 16 years) and female, had an education level of high school or less, and were of Mestizo ethnicity. The most commonly affected joints were the small joints, including the wrists, ankles, and fingers. The initial virus symptoms lasted a median of 4 days (interquartile range [IQR] 3-8 days). Sixteen percent of the participants reported missing school or work (median 4 days [IQR 2-7 days]). After 20 months, one-fourth of the participants had persistent joint pain. A multivariable analysis indicated that significant predictors of persistent joint pain included college graduate status, initial symptoms of headache or knee pain, missed work, normal activities affected, ≥4 days of initial symptoms, and ≥4 weeks of initial joint pain.

Conclusion: This is the first report to describe the frequency of chikungunya virus-related arthritis in the Americas after a 20-month follow-up. The high frequency of chronic disease highlights the need for the development of prevention and treatment methods.

Figure 1.

Study flow diagram. There was a chikungunya virus (CHIKV) epidemic 2014 to 2015 in Atlántico Department, Colombia with 2,517 affected at the time of the study enrollment. 500 clinically confirmed cases were referred for the study, of which 494 were serologically confirmed. There was no attrition. All patients completed the follow-up telephonic survey at median 20-months post-infection.