Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study
- Equal contributors
1 Centre for Clinical Investigation-Clinical Epidemiology (CIC-EC) of La Réunion (INSERM/CHU/Université de La Réunion/URMLR-OI), Groupe Hospitalier Sud Réunion, Avenue François Mitterrand, 97448 Saint Pierre cedex, La Réunion, France
2 Neonatal and Paediatric Intensive Care Unit, CHU, Groupe Hospitalier Sud Réunion, Avenue François Mitterrand, 97448 Saint Pierre cedex, La Réunion, France
3 UMRS 953, "Epidemiological Research Unit on Perinatal Health and Women and Children Health" (INSERM/Assistance Publique des Hôpitaux de Paris), Maternité de Port Royal, 53, avenue de l'Observatoire, 75014 Paris, France
4 Bacteriology - Virology - Parasitology - Hygiene, CHU, Groupe Hospitalier Sud Réunion, Avenue François Mitterrand, 97448 Saint Pierre cedex, La Réunion, France
5 Virology Unit, CHU, Hôpital Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux cedex, France
6 Rheumatology Clinic, Neurology, CHU, Groupe Hospitalier Sud Réunion, Avenue François Mitterrand, 97448 Saint Pierre cedex, La Réunion, France
7 Infectious Diseases, CHU, Groupe Hospitalier Sud Réunion, Avenue François Mitterrand, 97448 Saint Pierre cedex, La Réunion, France
8 Polyvalent Intensive Care Unit, CHU, Centre Hospitalier Félix Guyon, allée des Topazes, 97400 Saint Denis, La Réunion, France
9 Internal Medicine and Tropical Diseases; Centre of Tropical Medicine René Labusquière, CHU, Hôpital Saint André, 1, rue Jean Burguet, 33075 Bordeaux cedex, France
10 U897, "Epidemiology and Biostatistics", Institute of Public Health, Epidemiology and Development (INSERM/CHU/Université de Bordeaux 2 Victor Ségalen), 146, rue Léon Saignat, 33076 Bordeaux cedex, France
Arthritis Research & Therapy 2013, 15:R9 doi:10.1186/ar4137Published: 9 January 2013
Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R.
Three hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis.
Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms.
Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.