• Rahim Muhammad Associate Professor, Nephrology, BIRDEM
  • Zaman Shahana
  • Uddin Khwaja Nazim


chikungunya, post-chikungunya rheumatism, rheumatological diseases


Background: Disease chronicity of chikungunya among patients with pre-existing rheumatological diseases is not well-described in literature. This report describes a series of such cases and compares clinical presentation and disease chronicity with chikungunya patients without prior rheumatological diseases.

Methods: Patients’ clinical and laboratory data were recorded in case record forms. They were followed-up for three months for evaluating chronicity.

Results: Eight patients (mean age, 40.6 years; male, 6) with different pre-existing rheumatological diseases, complicated by chikungunya virus infection were analyzed. Their clinical presentation included fever (8), joint pain (8), rash (3), pruritus (3) and generalized body ache (4). Two patients (2/8, 25%) entered in chronic phase. When we compared the clinical manifestation and disease chronicity of chikungunya patients with and without prior rheumatological diseases, we found that clinical manifestation (fever, 100% vs 86.9%, p = 0.276; joint pain, 100% vs 88.8%, p = 0.319; rash, 37.5% vs 23.4%, p = 0.372; pruritus, 37.5% vs 15.9%, p = 0.121) were similar but higher percentage of patients of the former group entered in chronic phage (25% vs 9.1%, p = 0.153).

Conclusion: In spite of similar initial clinical presentation, higher frequency of patients with pre-existing rheumatological diseases, had post-chikungunya rheumatism.


1. Kabir I, Dhimal M, Müller R, Banik S, Haque U. The 2017 Dhaka chikungunya outbreak. Lancet Infect Dis 2017;17:1118. 10.1016/S1473-3099(17)30564-9
2. Rahim MA, Uddin KN. Chikungunya: an emerging viral infection with varied clinical presentations in Bangladesh: Reports of seven cases. BMC Res Notes 2017;15;10(1):410.
3. Paixão ES, Rodrigues LC, Costa MDCN, et al. Chikungunya chronic disease: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2018; 112: 301–316.
4. Rodríguez-Morales AJ, Cardona-Ospina JA, Urbano-Garzón SF, et al. Prevalence of postchikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis. Arthritis Care Res 2016;68(12):1849–1458.
5. Bouquillard E, Combe B. A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years. Joint Bone Spine 2009 Dec;76(6):654-657.
6. Rahim MA, Zaman S, Jahan I, et al. Socio-demographic, Clinical and Laboratory Characteristics of a Chikungunya Cohort from the 2017 Dhaka Outbreak of Bangladesh. BIRDEM Med J 2019; 9(2):106–110.
7. Bonifay T, Lienne JF, Bagoée C, et al. Prevalence and risk factors of post chikungunya rheumatic musculoskeletal disorders: a prospective follow up study in French Guiana. Eur J Clin Microbiol Infect Dis 2018 Nov;37(11):2159-64.
8. Consuegra-Rodríguez MP, Hidalgo-Zambrano DM, Vásquez-Serna H, Jimenez-Canizales CE, Parra-Valencia E, Rodriguez-Morales AJ. Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia. Travel Med Infect Dis 2018 Jan - Feb; 21:62-68.
9. Bertolotti A, Thioune M, Abel S, et al. Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique): A prospective cohort study. PLoS Negl Trop Dis 2020; 14 (3): e0007327.
10. Amaral JK, Schoen RT. A Case Report of Chikungunya Fever, Rheumatoid Arthritis, and Felty’s Syndrome. Rheumatol Ther 2018;5:293–301.
11. Fuentes-Silva Y, Acosta C, Ortega L, Al Snih S, Amaya I, Maldonado I. Rheumatic Conditions Appearing De Novo after Infection with Chikungunya Virus in Venezuelan Patients [abstract]. Arthritis Rheumatol 2017; 69 (suppl 10). conditions-appearing-de-novo-afterinfection-with-chikungunya-virus-in-venezuelan-patients/. Accessed October 12, 2019.
12. Marques CDL, Duarte ALPD, Ranzolin A, et al. Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part2 – Treatment. Rev Bras Reumatol 2017; 57(S2): S438–S451.