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Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort
BACKGROUND: Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25–40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persi...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851532/ https://www.ncbi.nlm.nih.gov/pubmed/36608155 http://dx.doi.org/10.1371/journal.pntd.0011037 |
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author | Lázari, Carolina dos Santos Ramundo, Mariana Severo ten-Caten, Felipe Bressan, Clarisse S. de Filippis, Ana Maria Bispo Manuli, Erika Regina de Moraes, Isabella Pereira, Geovana Maria Côrtes, Marina Farrel Candido, Darlan da Silva Gerber, Alexandra L. Guimarães, Ana Paula Faria, Nuno Rodrigues Nakaya, Helder I. Vasconcelos, Ana Tereza R. Brasil, Patrícia Paranhos-Baccalà, Gláucia Sabino, Ester Cerdeira |
author_facet | Lázari, Carolina dos Santos Ramundo, Mariana Severo ten-Caten, Felipe Bressan, Clarisse S. de Filippis, Ana Maria Bispo Manuli, Erika Regina de Moraes, Isabella Pereira, Geovana Maria Côrtes, Marina Farrel Candido, Darlan da Silva Gerber, Alexandra L. Guimarães, Ana Paula Faria, Nuno Rodrigues Nakaya, Helder I. Vasconcelos, Ana Tereza R. Brasil, Patrícia Paranhos-Baccalà, Gláucia Sabino, Ester Cerdeira |
author_sort | Lázari, Carolina dos Santos |
collection | PubMed |
description | BACKGROUND: Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25–40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. METHODOLOGY/PRINCIPAL FINDINGS: We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15–1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09–1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12–1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44–9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51–11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58–5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24–0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). CONCLUSION: This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease’s evolution and improve patients’ management, modifying CHIKF burden on global public health. |
format | Online Article Text |
id | pubmed-9851532 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-98515322023-01-20 Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort Lázari, Carolina dos Santos Ramundo, Mariana Severo ten-Caten, Felipe Bressan, Clarisse S. de Filippis, Ana Maria Bispo Manuli, Erika Regina de Moraes, Isabella Pereira, Geovana Maria Côrtes, Marina Farrel Candido, Darlan da Silva Gerber, Alexandra L. Guimarães, Ana Paula Faria, Nuno Rodrigues Nakaya, Helder I. Vasconcelos, Ana Tereza R. Brasil, Patrícia Paranhos-Baccalà, Gláucia Sabino, Ester Cerdeira PLoS Negl Trop Dis Research Article BACKGROUND: Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25–40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. METHODOLOGY/PRINCIPAL FINDINGS: We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15–1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09–1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12–1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44–9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51–11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58–5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24–0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). CONCLUSION: This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease’s evolution and improve patients’ management, modifying CHIKF burden on global public health. Public Library of Science 2023-01-06 /pmc/articles/PMC9851532/ /pubmed/36608155 http://dx.doi.org/10.1371/journal.pntd.0011037 Text en © 2023 Lázari et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lázari, Carolina dos Santos Ramundo, Mariana Severo ten-Caten, Felipe Bressan, Clarisse S. de Filippis, Ana Maria Bispo Manuli, Erika Regina de Moraes, Isabella Pereira, Geovana Maria Côrtes, Marina Farrel Candido, Darlan da Silva Gerber, Alexandra L. Guimarães, Ana Paula Faria, Nuno Rodrigues Nakaya, Helder I. Vasconcelos, Ana Tereza R. Brasil, Patrícia Paranhos-Baccalà, Gláucia Sabino, Ester Cerdeira Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title | Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title_full | Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title_fullStr | Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title_full_unstemmed | Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title_short | Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort |
title_sort | clinical markers of post-chikungunya chronic inflammatory joint disease: a brazilian cohort |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851532/ https://www.ncbi.nlm.nih.gov/pubmed/36608155 http://dx.doi.org/10.1371/journal.pntd.0011037 |
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