Chikungunya & Joint Pains

How is Chikungunya diagnosed?

Initially, a strong suspicion is necessary. Many other illnesses may appear like Chikungunya. Typically fever, headache, skin. rashes, muscle pains, and body aches are present. Blood tests include viral PCR that is positive from the first day to the fifth day, IGM will be positive from day 7 to 2 to 3 months, and IGA from day 7 onwards. In the chronic phase that is after 3 months, IGA remains positive. After 3 months in individuals with joint pains, Rheumatoid factor, and CCP, and in some HLA B 27 is suggested.

Which is the more vulnerable group of patients of Chikungunya to have arthritis?

Arthritis causes personal, social, and economic distress and loss of productivity. It has the worst manifestations in children, the elderly, and patients with chronic hypertension, kidney disorders, diabetes, heart diseases, and previous rheumatology problems.

How long does the arthritis persist?

Post Chikungunya arthritis may persist for months to years contributing to the disease burden in society. There are a few similarities between post-Chikungunya virus arthritis and Rheumatoid arthritis. There are certain dissimilarities as well.

Which joints are affected in Chikungunya?

All major joints are affected. In this year’s epidemic we found most of arthritis victims to have pain and swelling at the ankles and toes. Pain in knees, hips, back elbows, and shoulders are other common sites. Swelling over the feet is an accompaniment in most individuals with ankle arthritis. In addition to joint pain, pain in the muscles is another common feature.

Can more severely affected individuals have serious features other than arthritis ?

More severely affected patients can develop neurological disorders including encephalitis, myelitis, and peripheral neuropathy. Eye involvement can cause keratitis, episcleritis, optic neuropathy, and retinal involvement. Irregular heartbeats and dilated hearts are cardiovascular manifestations. Low platelets and low WBC count are common.

How do we differentiate Chikungunya arthritis from Rheumatoid arthritis?

Though in the very initial phases, it is easy, in chronic arthritis lasting over 3 months this may be difficult. The specific involvement of wrists and small joints of hands makes Rheumatoid arthritis more likely. Predominant involvement of ankles and toes makes Chikungunya more likely. However, specific blood tests may differentiate between the two.

Should you worry about joint pains in post-Chikungunya arthritis?

In more than 30% of cases, the arthritis may become chronic and disabling. They may require long-term treatment and rehabilitation.

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Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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