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Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 287-288

Clinical manifestations of chikungunya fever in patients with ankylosing spondylitis

Consultant Rheumatologist, Apollo Hospitals, Indore, Madhya Pradesh, India

Date of Web Publication18-Nov-2018

Correspondence Address:
Dr. Akshat Pandey
A-4, MIG Colony, Behind Hotel Amaltas, Indore - 452 001, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_122_18

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How to cite this article:
Pandey A. Clinical manifestations of chikungunya fever in patients with ankylosing spondylitis. Indian J Rheumatol 2018;13:287-8

How to cite this URL:
Pandey A. Clinical manifestations of chikungunya fever in patients with ankylosing spondylitis. Indian J Rheumatol [serial online] 2018 [cited 2020 May 30];13:287-8. Available from:

Dear Editor,

Chikungunya virus infects over 1 million people every year, and causes fever, arthritis, arthralgias, myalgias, rash, and fatigue.[1],[2] Chikungunya virus might also trigger or resemble rheumatoid arthritis, ankylosing spondylitis (AS), or psoriatic arthritis. AS causes inflammatory back pain which is generally not relived by rest but improves with movements and anti-inflammatory agents. The extra-articular manifestations of AS include acute anterior uveitis and it is also associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).[3] We report the clinical manifestations of chikungunya fever in patients with AS visiting our tertiary care center, following an outbreak of chikungunya in Indore city of Madhya Pradesh, India from July to September 2017.

A total of 32 patients (24 males and 8 females) who had a diagnosis of AS and were on treatment for it was assessed. They had presented with acute fever (<7 days) and joint pain. The majority of participants (12) were in the age group of 21–30 years with disease duration between 1 and 3 years. Twenty-six patients had tender and swollen joints, whereas six patients had arthralgias. New onset of knee joint pain, ankle joint pain, backache, and small joint involvement was reported by 26, 30, 28, and 24 patients, respectively. A typical maculopapular rash at the onset of fever was seen in 24, whereas two patients who were on etanercept therapy reported ocular manifestations in the form of recurrence of uveitis. Neurological symptoms such as tingling and numbness over the extremities were seen in five patients, four among them had a headache, and two had vestibular symptoms. Five reported painful oral ulcers and three reported temporomandibular joint pain. None of the patients in the present study had any organ failure. A significant [Table 1] fall in the mean hemoglobin, mean white blood cells count was seen, whereas a significant rise in erythrocyte sedimentation rate and C-reactive protein level was seen in the patients with AS before and after chikungunya infection. The Bath AS Disease Activity Index (BASDAI)[4] did not show an increase in 25 patients implying no increase in disease activity. Fifteen patients had immunoglobulin M (IgM) chikungunya positivity, whereas in the patients with negative IgM chikungunya by ELISA, reverse transcriptase-polymerase chain reaction was positive in 9, negative in 3 and was not performed in five patients.[5] No mortality was reported.
Table 1: Comparison of hematological parameters before and after chikungunya in patients with ankylosing spondylitis

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We found that in our small cohort chikungunya fever in patients with AS resulted in wide variety of manifestations causing severe pain and discomfort. Diverse blood findings were also noted. However, it is intriguing that BASDAI did not show any increase. We treated our patients with paracetamol, nonsteroidal anti-inflammatory drugs, and glucorticoids with resolution of symptoms and signs within 4 weeks. Eight out of 32 patients required long (up to 12 weeks) follow-up due to persistent synovitis and were treated with hydroxychloroquine and tapering dose of glucocorticoids and gradually improved.

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There are no conflicts of interest.

  References Top

Mathew AJ, Ravindran V. Infections and arthritis. Best Pract Res Clin Rheumatol 2014;28:935-59.  Back to cited text no. 1
Rougeron V, Sam IC, Caron M, Nkoghe D, Leroy E, Roques P, et al. Chikungunya, a paradigm of neglected tropical disease that emerged to be a new health global risk. J Clin Virol 2015;64:144-52.  Back to cited text no. 2
Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: An overview. Ann Rheum Dis 2002;61 Suppl 3:iii8-18.  Back to cited text no. 3
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A, et al. Anew approach to defining disease status in ankylosing spondylitis: The bath ankylosing spondylitis disease activity index. J Rheumatol 1994;21:2286-91.  Back to cited text no. 4
Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, et al. Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res 2013;99:345-70.  Back to cited text no. 5


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