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Arthritis Rheumatol. 2015 May;67(5):1214-1220. doi: 10.1002/art.39027.

Chikungunya viral arthritis in the United States: a mimic of seronegative rheumatoid arthritis.

Author information

1
Rheumatology Division, Washington University School of Medicine, St. Louis, United States 63110.
2
Infectious Disease Division, Washington University School of Medicine, St. Louis, United States 63110.
3
The Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, United States 63110.
4
Hematology Division, Washington University School of Medicine, St. Louis, United States 63110.
5
Department of Medicine; Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, United States 63110.
6
Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, United States 63110.
7
Howard Hughes Medical Institute; Washington University School of Medicine, St. Louis, United States 63110.
#
Contributed equally

Abstract

OBJECTIVE:

Chikungunya virus (CHIKV) is an arthritogenic mosquito-transmitted alphavirus that spread to the Caribbean in 2013 and to the US in 2014. CHIKV-infected patients develop inflammatory arthritis that can persist for months or years, but little is known about the rheumatologic and immunologic features of CHIKV-related arthritis in humans, particularly as compared to rheumatoid arthritis (RA). The purpose of this study was to describe these features in a group of 10 American travelers who were nearly simultaneously infected while visiting Haiti in June 2014.

METHODS:

Patient history was obtained and physical examination and laboratory tests were performed. All patients with CHIKV-related arthritis had detectable levels of anti-CHIKV IgG. Using cytometry by time-of-flight (CyTOF), we analyzed peripheral blood mononuclear cells in CHIKV-infected patients, healthy controls, and patients with untreated, active RA.

RESULTS:

Among 10 CHIKV-infected individuals, 8 developed persistent symmetric polyarthritis that met the American College of Rheumatology/European League Against Rheumatism 2010 criteria for (seronegative) RA. CyTOF analysis revealed that RA and CHIKV-infected patients had greater percentages of activated and effector CD4+ and CD8+ T cells than healthy controls.

CONCLUSION:

In addition to similar clinical features, patients with CHIKV infection and patients with RA develop very similar peripheral T cell phenotypes. These overlapping clinical and immunologic features highlight a need for rheumatologists to consider CHIKV infection when evaluating patients with new, symmetric polyarthritis.

PMID:
25605621
PMCID:
PMC4591551
DOI:
10.1002/art.39027
[Indexed for MEDLINE]
Free PMC Article

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