Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Clinical Trial

Chikungunya Arthritis Treatment with Methotrexate and Dexamethasone: A Randomized, Double-blind, Placebo-controlled Trial

Author(s): José Kennedy Amaral*, Gabriela Lucena and Robert Taylor Schoen

Volume 20, Issue 3, 2024

Published on: 02 January, 2024

Page: [337 - 346] Pages: 10

DOI: 10.2174/0115733971278715231208114037

Price: $65

conference banner
Abstract

Background: Chikungunya fever is a reemerging epidemic disease caused by a single-stranded RNA alphavirus transmitted throughout by Aedes mosquitoes. Chikungunya virus infection is a biphasic disease in which 72% to 95% of affected individuals manifest acute chikungunya fever. Following the acute phase, more than 40% of affected individuals develop arthritis, often lasting more than 3 months, referred to as chronic chikungunya arthritis, which frequently mimics rheumatoid arthritis.

Objective: This study aimed to evaluate the efficacy and safety of treatment of chronic chikungunya arthritis with methotrexate and dexamethasone in a randomized, double-blind, placebo-controlled clinical trial.

Methods: The patients were reassessed for treatment response by the DAS28-ESR, tender joint count and swollen joint count, Patient Global Assessment, and for secondary measures, including the Health Assessment Questionnaire Disability Index and Pain Visual Analog Scale.

Results: Thirty-one subjects were randomized (placebo, n = 16; methotrexate, n = 15); 27 completed treatment and 4 discontinued during the 8-week blinded period. Among the participants, 96.8% were female, with mean ± SD age was 52.9 ± 13. The mean ± SD disease duration prior to treatment was 220.9 ± 51.2 days. At 8 weeks, methotrexate-treated subjects showed a greater numerical trend towards improvement, but there were no significant differences between methotrexate- dexamethasone group and dexamethasone (placebo) group.

Conclusion: In this relatively small cohort, all of whom received background dexamethasone, there was a greater numerical improvement trend in prespecified outcome measures, but methotrexate in combination with dexamethasone was not superior to dexamethasone in chronic chikungunya arthritis.

Keywords: Chikungunya, methotrexate, arthritis, dexamethasone, virus, DMARD.

« Previous
Graphical Abstract

[1]
Amaral JK, Pal T, Schoen RT. Chikungunya arthritis. In: Ravindran V, Ed. Rarer Arthropathies. Rare Diseases of the Immune System 2022.
[http://dx.doi.org/10.1007/978-3-031-05002-2_14]
[2]
Thiberville SD, Moyen N, Dupuis-Maguiraga L, et al. Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res 2013; 99(3): 345-70.
[http://dx.doi.org/10.1016/j.antiviral.2013.06.009] [PMID: 23811281]
[3]
Amaral JK, Bilsborrow JB, Schoen RT. Chronic chikungunya arthritis and rheumatoid arthritis: What they have in common. Am J Med 2020; 133(3): e91-7.
[http://dx.doi.org/10.1016/j.amjmed.2019.10.005] [PMID: 31705850]
[4]
Ross RW. The Newala epidemic: III. The virus: Isolation, pathogenic properties and relationship to the epidemic. J Hyg 1956; 54(2): 177-91.
[http://dx.doi.org/10.1017/S0022172400044442] [PMID: 13346078]
[5]
Wahid B, Ali A, Rafique S, Idrees M. Global expansion of chikungunya virus: mapping the 64-year history. Int J Infect Dis 2017; 58: 69-76.
[http://dx.doi.org/10.1016/j.ijid.2017.03.006] [PMID: 28288924]
[6]
Sergon K, Onyango C, Breiman RF, et al. Seroprevalence of chikungunya virus (CHIKV) infection on Lamu Island, Kenya, October 2004. Am J Trop Med Hyg 2008; 78(2): 333-7.
[http://dx.doi.org/10.4269/ajtmh.2008.78.333] [PMID: 18256441]
[7]
Cassadou S, Boucau S, Petit-Sinturel M, Huc P, Leparc-Goffart I, Ledrans M. Emergence of chikungunya fever on the French side of Saint Martin island, October to December 2013. Euro Surveill 2014; 19(13): 20752.
[http://dx.doi.org/10.2807/1560-7917.ES2014.19.13.20752] [PMID: 24721536]
[8]
Yactayo S, Staples JE, Millot V, Cibrelus L, Ramon-Pardo P. Epidemiology of chikungunya in the Americas. J Infect Dis 2016; 214 (Suppl. 5): S441-5.
[http://dx.doi.org/10.1093/infdis/jiw390] [PMID: 27920170]
[9]
da Silva RB, de Araujo MIF, Barbosa PP de S. Dengue, zika fever and chikungunya: Biological aspects and situation in South America between 2015 and 2020. RSD 2021. Available from: rsdjournal.org/index.php/rsd/article/view/15539 [cited: 06 March 2023].
[10]
Ministry of health of brazil department of health surveillance boletim epidemiológico monitoring of cases of dengue and chikungunya fever until epidemiological week 2022. Available from: www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2022/boletim-epidemiologico-vol-53-no44/view [cited: 06 March 2023].
[11]
Pan american health organization. Cases of chikungunya virus disease IOP Publishing PAHO 2023. Available from: www3.paho.org/data/index.php/en/mnu-topics/chikv-en/550-chikv-weekly-en.html Accessed on 06 March 2023
[12]
Hoarau JJ, Bandjee MC, Trotot P, et al. Persistent chronic inflammation and infection by Chikungunya arthritogenic alphavirus in spite of a robust host immune response. J Immunol 2010; 184(10): 5914-27.
[http://dx.doi.org/10.4049/jimmunol.0900255] [PMID: 20404278]
[13]
Chaaithanya IK, Muruganandam N, Sundaram SG, et al. Role of proinflammatory cytokines and chemokines in chronic arthropathy in CHIKV infection. Viral Immunol 2011; 24(4): 265-71.
[http://dx.doi.org/10.1089/vim.2010.0123] [PMID: 21830898]
[14]
Webb E, Michelen M, Rigby I, et al. An evaluation of global Chikungunya clinical management guidelines: A systematic review. EClinicalMedicine 2022; 54: 101672.
[http://dx.doi.org/10.1016/j.eclinm.2022.101672] [PMID: 36193172]
[15]
World health organization. Guidelines on clinical management of chikungunya fever IOP Publishing WHO 2008. Available from: www.who.int/publications/i/item/guidelines-on-clinical-management-of-chikungunya-fever [cited: 14 April 2023].
[16]
Marques CDL, Duarte ALBP, Ranzolin A, et al. Recommendations of the Brazilian society of rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment. Rev Bras Reumatol Engl 2017; 2(57 Suppl ): 438-51.
[17]
Amaral JK, Sutaria R, Schoen RT. Treatment of chronic chikungunya arthritis with methotrexate: A systematic review. Arthritis Care Res 2018; 70(10): 1501-8.
[http://dx.doi.org/10.1002/acr.23519] [PMID: 29361202]
[18]
Javelle E, Ribera A, Degasne I, Gaüzère BA, Marimoutou C, Simon F. Specific management of post-chikungunya rheumatic disorders: A retrospective study of 159 cases in reunion island from 2006-2012. PLoS Negl Trop Dis 2015; 9(3): e0003603.
[http://dx.doi.org/10.1371/journal.pntd.0003603] [PMID: 25760632]
[19]
Guillot X, Ribera A, Gasque P. Chikungunya-induced arthritis in reunion island: A long-term observational follow-up study showing frequently persistent joint symptoms, some cases of persistent chikungunya immunoglobulin M positivity, and no anticyclic citrullinated peptide seroconversion after 13 years. J Infect Dis 2020; 222(10): 1740-4.
[http://dx.doi.org/10.1093/infdis/jiaa261] [PMID: 32428203]
[20]
Adarsh MB, Sharma SK, Dwivedi P, Singh MP, Dhir V, Jain S. Methotrexate in early chikungunya arthritis: A 6 month randomized controlled open-label trial. Curr Rheumatol Rev 2020; 16(4): 319-23.
[http://dx.doi.org/10.2174/1573397115666190925154140] [PMID: 31858912]
[21]
Malvy D, Ezzedine K, Mamani-Matsuda M, et al. Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies. BMC Infect Dis 2009; 9(1): 200.
[http://dx.doi.org/10.1186/1471-2334-9-200] [PMID: 20003320]
[22]
Manimunda SP, Vijayachari P, Uppoor R, et al. Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging. Trans R Soc Trop Med Hyg 2010; 104(6): 392-9.
[http://dx.doi.org/10.1016/j.trstmh.2010.01.011] [PMID: 20171708]
[23]
Chaaithanya IK, Muruganandam N, Raghuraj U, et al. Chronic inflammatory arthritis with persisting bony erosions in patients following chikungunya infection. Indian J Med Res 2014; 140(1): 142-5.
[PMID: 25222790]

Rights & Permissions Print Cite
Article Metrics
28
1
Wayfinder Image
© 2024 Bentham Science Publishers | Privacy Policy