{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:08:29Z","timestamp":1792642109318,"version":"4.5.0"},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Chikungunya fever is a global vector-borne viral disease. Patients with acute chikungunya are usually treated symptomatically. The arthritic phase may be self-limiting. However, many patients develop extremely disabling arthritis that does not improve after months. The aim of this study was to describe the treatment of chikungunya arthritis (CHIKA) patients. A medical records review was conducted in 133 CHIKA patients seen at a rheumatology practice. Patients were diagnosed by clinical criteria and confirmed by the presence of anti-chikungunya IgM. Patients were treated with methotrexate (20\u2009mg\/week) and\/or leflunomide (20\u2009mg\/day) and dexamethasone (0\u20134\u2009mg\/day) for 4 weeks. At baseline visit and 4 weeks after treatment, Disease Activity Score 28 (DAS28) and pain (using a visual analog scale) were ascertained. Five months after the end of treatment, patients were contacted to assess pain, tender joint count, and swollen joint count. The mean age of patients was 58.6 \u00b1 13.7 years, and 119 (85%) were female. After 4 weeks of treatment, mean (SD) DAS28-erythrocyte sedimentation rate (6.0 [1.2] versus 2.7 [1.0],\n                    <jats:italic>P\u2009&lt;\u2009<\/jats:italic>\n                    0.001) and pain (81.8 [19.2] to 13.3 [22.9],\n                    <jats:italic>P &lt;<\/jats:italic>\n                    0.001) scores significantly decreased. A total of 123 patients were contacted 5 months after the end of treatment. Pain score, tender joint count, and swollen joint count significantly declined after 4 weeks of treatment, and the response was sustained for 5 months. In this group of patients with CHIKA, 4-week treatment induced a rapid clinical improvement that was maintained 5 months after the end of therapy; however, the contribution of treatment to these outcomes is uncertain.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.23-0205","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T10:52:45Z","timestamp":1691405565000},"page":"542-547","source":"Crossref","is-referenced-by-count":15,"title":["Therapy for Chikungunya Arthritis: A Study of 133 Brazilian Patients"],"prefix":"10.4269","volume":"109","author":[{"given":"Jos\u00e9 Kennedy","family":"Amaral","sequence":"first","affiliation":[{"name":"Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifton O.","family":"Bingham","sequence":"additional","affiliation":[{"name":"Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Vil\u00e1","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Weinblatt","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Harvard Medical School Clinical, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert T.","family":"Schoen","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"N Engl J Med","first-page":"1231","article-title":"Chikungunya virus and the global spread of a mosquito-borne disease","volume":"372","author":"Weaver","year":"2015"},{"key":"b2","series-title":"J Rheumatol","first-page":"1491","article-title":"Chikungunya in Brazil: rheumatologists on the front line","volume":"45","author":"Amaral","year":"2018"},{"key":"b3","series-title":"PLoS One","first-page":"e0249867","article-title":"Rheumatic manifestations of chikungunya virus infection: prevalence, patterns, and enthesitis","volume":"16","author":"Benjamanukul","year":"2021"},{"key":"b4","series-title":"Arthritis Care Res (Hoboken)","first-page":"1849","article-title":"Prevalence of post-chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis","volume":"68","author":"Rodriguez-Morales","year":"2016"},{"key":"b5","series-title":"F1000 Res","first-page":"360","article-title":"Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia","volume":"5","author":"Rodriguez-Morales","year":"2016"},{"key":"b6","series-title":"Med Mal Infect","first-page":"243","article-title":"French guidelines for the management of chikungunya (acute and persistent presentations)","volume":"45","author":"Simon","year":"2015"},{"key":"b7","series-title":"Arthritis Care Res (Hoboken)","first-page":"1501","article-title":"Treatment of chronic chikungunya arthritis with methotrexate: a systematic review","volume":"70","author":"Amaral","year":"2018"},{"key":"b8","series-title":"J Clin Rheumatol","first-page":"119","article-title":"Successful methotrexate treatment of chronic chikungunya arthritis","volume":"26","author":"Amaral","year":"2020"},{"key":"b9","series-title":"Rev Bras Reumatol Engl","first-page":"438","article-title":"Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. 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post-chikungunya does not impair the synovial antiviral and bone repair responses","volume":"12","author":"Bedoui","year":"2018"},{"key":"b19","series-title":"Ann Rheum Dis","first-page":"1100","article-title":"Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research","volume":"68","author":"Salliot","year":"2009"},{"key":"b20","series-title":"PLoS Negl Trop Dis","first-page":"e1517","article-title":"Clinical forms of chikungunya in Gabon, 2010","volume":"6","author":"Nkoghe","year":"2012"},{"key":"b21","series-title":"Clin Infect Dis","first-page":"1401","article-title":"Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients","volume":"44","author":"Borgherini","year":"2017"},{"key":"b22","series-title":"PLoS Negl Trop Dis","first-page":"e2004","article-title":"Chikungunya fever: a clinical and virological investigation of outpatients on Reunion Island, South-West Indian Ocean","volume":"7","author":"Thiberville","year":"2013"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"405","article-title":"Clinical and laboratory characteristics of an acute chikungunya outbreak in Bangladesh in 2017","volume":"100","author":"Rahman","year":"2019"},{"key":"b24","series-title":"Arthritis Rheumatol","first-page":"2817","article-title":"Management of chronic post-chikungunya rheumatic disease: the Martinican experience","volume":"68","author":"Blettery","year":"2016"},{"key":"b25","series-title":"Arthritis Rheumatol","first-page":"585","article-title":"Chikungunya arthritis mechanisms in the Americas: a cross-sectional analysis of chikungunya arthritis patients twenty-two months after infection demonstrating no detectable viral persistence in synovial fluid","volume":"70","author":"Chang","year":"2018"},{"key":"b26","series-title":"Sci Rep","first-page":"18578","article-title":"Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis","volume":"11","author":"Watson","year":"2021"},{"key":"b27","series-title":"J Rheumatol","first-page":"1267","article-title":"Chronic joint pain 3 years after chikungunya virus infection largely characterized by relapsing-remitting symptoms","volume":"47","author":"Tritsch","year":"2020"},{"key":"b28","series-title":"J Rheumatol","first-page":"1784","article-title":"Systematic review and metaanalysis of the reproducibility of patient self-reported joint counts in rheumatoid arthritis","volume":"48","author":"Rampes","year":"2021"}],"container-title":["The American Journal of Tropical Medicine and 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