{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T11:48:49Z","timestamp":1793965729178,"version":"4.8.0"},"reference-count":130,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Chronic chikungunya arthritis (CCA) is a major long-term sequela of Chikungunya virus (CHIKV) infection. Its pathogenesis involves persistent viral reservoirs in joint tissues, metabolic reprogramming of myeloid cells, dysregulated Treg\/Th17 immunity, and autoimmune-like tissue injury. This review integrates recent advances in virology, immunometabolism, and clinical pathology to propose a four-stage pathological cascade: \u201cviral persistence\u201d, \u201cmyeloid metabolic dysregulation\u201d, \u201cTreg\/Th17 imbalance\u201d, and \u201cautoimmunity-like injury\u201d. Key cytokine networks and molecular interactions at each stage are summarized. Based on this model, we outline stage-specific therapeutic strategies, including antiviral agents targeting Mxra8 or nsP1 (Stage I), metabolic modulators such as HIF-1\u03b1 inhibitors and IL-1\u03b2 blockade (Stage II), immune-restorative therapies such as low-dose IL-2 and CTLA-4-Ig (Stage III), and anti-inflammatory biologics or DMARDs for RA-like pathology (Stage IV). This framework provides a mechanistic basis for precision intervention and supports the development of biomarkers and clinical trial designs for CCA.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1775493","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T05:27:17Z","timestamp":1777267637000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Immunopathological mechanisms and targeted intervention strategies for chronic chikungunya arthritis: from viral persistence to autoimmunity"],"prefix":"10.3389","volume":"17","author":[{"given":"Linsheng","family":"Zeng","sequence":"first","affiliation":[{"name":"Faculty of Chinese Medicine, Macau University of Science and Technology","place":["Macao SAR, China"]},{"name":"Emergency Department, Shenzhen Traditional Chinese Medicine Hospital","place":["Shenzhen, 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