Arthralgia resolution rate following chikungunya virus infection

Abstract

Background: Arthralgia, persistent pain or stiffness of the joints, is the hallmark symptom of chronic chikungunya virus (CHIKV) disease. Associated with significant disability and reduced quality of life, arthralgia can persist for many months following CHIKV infection. Understanding the expected duration of arthralgia persistence is important for managing clinical expectations at the individual-level as well as for estimating long-term burdens on population health following a CHIKV epidemic.

Methods: A review of cohort studies reporting the prevalence of arthralgia post-CHIKV infection over multiple time points was conducted. Generalized linear models were used to estimate the average rate of arthralgia resolution following CHIKV infection.

Results: Sixteen cohort studies matching the inclusion criteria were identified and included in the analysis. An average rate of arthralgia resolution of 10.85% (95% confidence interval (CI) 9.05-12.66%) per month was estimated across studies, corresponding to an expected median time to arthralgia resolution of 6.39 months (95% CI 5.48-7.66 months) and an expected arthralgia prevalence of 72.21% (95% CI 68.40-76.23%) at 3 months post-CHIKV infection.

Conclusions: Estimates of the average rate of arthralgia resolution and the expected prevalence of arthralgia over time post-CHIKV infection were derived. These can help inform expectations regarding the long-term public health burdens associated with CHIKV epidemics.

Keywords: Arthralgia; Chikungunya; Chronic disease; Infection; Joint pain; Virus.

Figure 1

(A) Map of the study locations. Colored points indicate the location of each study, where the point size represents the relative study sample size. (B) Reported prevalence of arthralgia for each study by month post chikungunya virus infection.

Figure 2

Estimated prevalence of arthralgia by months post-chikungunya virus infection. Gray points and lines indicate the reported mean prevalence of arthralgia and the 95% binomial confidence intervals. The purple line and ribbon show the mean and 95% confidence interval for expected arthralgia prevalence estimated across all studies.

Figure 3

Estimated rates of resolution by study. (A) Estimated prevalence of arthralgia by months post infection by study. The green lines and ribbons indicate the model mean and 95% confidence interval estimates. The gray points and lines indicate the reported prevalence of arthralgia and 95% binomial confidence intervals. (B) Estimated rate of resolution per month by study. The points and lines indicate mean and 95% confidence intervals. The horizontal dashed line and ribbon indicate the mean and 95% confidence interval estimates from summary model 1. (C) Estimated median time to resolution by study. The points and lines indicate the mean and 95% confidence intervals. The horizontal dashed line and ribbon indicate the mean and 95% confidence interval estimates from summary model 1.

Figure 4

Prevalence of arthralgia by months post-chikungunya virus infection estimated by median cohort age (A), circulating viral genotype (B), study follow-up method (C), and region (D). The colored points and lines indicate the reported mean prevalence of arthralgia and 95% binomial confidence intervals. The colored lines and ribbon show the mean and 95% confidence interval for expected arthralgia prevalence estimated across studies by group.