Patients with chikungunya meeting criteria for inflammatory rheumatic diseases: a systematic literature review and meta-analysis.

Background: Chikungunya fever (CF) is marked by acute, subacute, and chronic phases, with a significant proportion of patients experiencing persistent joint and neuropathic pain. These symptoms may mimic those of rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). There is currently no consensus on whether the infection directly causes chronic joint disease or serves as an immunological trigger for the development of rheumatic conditions.

Aim: This study aims to evaluate the overall proportion of CF patients who progress to chronic arthropathy, and to identify how many of these patients meet the classification criteria for RA and SpA (including ankylosing spondylitis (AS) and psoriatic arthritis (PsA)).

Methods: A thorough search was conducted in electronic databases, including PubMed, Embase, LILACS, and the Cochrane Library. The primary endpoint was the occurrence of chronic arthropathy, defined as joint signs and symptoms lasting more than six weeks following the acute phase of CF. The secondary endpoint involved the proportion of patients meeting the classification criteria for RA, SpA, AS, and PsA. A random-effects meta-analysis model was utilized to combine studies and determine the pooled frequency of persistent joint symptoms. Subgroup analyses were performed based on the fulfillment of classification criteria for rheumatic diseases. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. The study protocol was registered with PROSPERO (CRD42020211430).

Results: A total of thirty-eight studies, comprising data from 12.524 individuals with CF published between 2008 and 2022, met the inclusion criteria. Of these, 4.324 (34.5%) patients developed chronic arthropathy; among them, 11.43% (240 in 2099) patients met the criteria for RA, 12.1% (86 in 711) patients for SpA, 3.42% (36 in 1052) patients for AS, and 2.05% (25 in 1220) patients for PsA.

Conclusion: This study found that approximately one-third of CF patients experience persistent joint pain lasting over six weeks. However, only a minority of these individuals meet classification criteria for rheumatic diseases.