Tariq Al-Araimi, MD; Shikha Mittoo, MD, MHS
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=L15-0053.
Al-Araimi T, Mittoo S. Chikungunya. Ann Intern Med. 2015;162:531-532. doi: 10.7326/L15-5076-2
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Published: Ann Intern Med. 2015;162(7):531-532.
TO THE EDITOR:
We read Hamer and Chen's article (1) with great interest. However, chronic chikungunya arthritis can persist for months after infection (2, 3). Among 47 travelers returning from the Indian Ocean islands, including Comoros, Mayotte, Mauritius, the Seychelles, and Réunion Island, followed for 14 months, late (developing after the 10th day) arthropathy—defined by the presence of at least 1 of the following symptoms: symmetric oligo- or polyarthritis accompanied by morning stiffness, nonspecific edema or tenosynovitis, or worsening of mechanical pain in a preexisting injured joint or bone—was identified in 38 persons ( 2). In another series of 21 cases of newly diagnosed chikungunya virus with a mean follow-up of 2 years, all patients fulfilled the American College of Rheumatology's criteria for rheumatoid arthritis, with symptoms starting from the onset of viral infection to rheumatoid arthritis diagnosis (3).
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