Prognosis

Chikungunya virus infection is generally a self-limiting disease that usually recovers spontaneously without sequelae. Some patients may evolve into a chronic condition with polyarthritis and systemic manifestations. The relative frequency of these manifestations is highly variable ranging between 14% and 87%.[53]

Death is rare. The highest case fatality rate was during the Réunion Island outbreak with 1 in 1000 cases.[103]

Chronic rheumatologic manifestations

Patients may develop symmetric polyarthritis that is usually incapacitating and resembles rheumatoid arthritis, but chronic monoarthritis or oligoarthritis can also occur following the acute infection. The course can be continuous or relapsing. Overall, the pain associated with these arthritides tends to decrease with time, but can persist for months and years. Radiologic imaging can show focal bony erosions, joint effusions, and bursitis. The clinical manifestations may be associated with persistence of immunoglobulin M (IgM) antibodies and interleukin-6 levels in serum and, occasionally, with positive rheumatoid factor or anti-cyclic citrullinated peptide antibodies.

There is currently no evidence of a definitive link between initial infection and the development of chronic arthritis.[104] However, 3 factors were associated with progression toward chronic disease in one study: age 45 to 59 years (adjusted odds ratio [OR]: 6.4, 95% confidence interval [CI]: 1.8, 22.1) or ≥60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial joint involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8), and high chikungunya virus IgG titers at the start of the disease (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per 1 unit increase).[5][105][106][107] A systematic review found that more than half of those infected will go on to experience chronic articular symptoms.[108]

Chronic systemic manifestations

In addition to rheumatologic symptoms, patients may exhibit neuropathic pain affecting the upper and lower limbs, chronic headache, fatigue, asthenia, and depression up to 6 years after the acute infection, in association with significant poor scores in different scales of quality of life (such as the 36-item short-form health survey [SF-36], Arthritis Impact Measurement Scales 2 [AIMS2-SF], and the General Health Questionnaire [GHQ-12]).[67][107]

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