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Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study.
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Edité par CCSD ; BioMed Central -
International audience. ABSTRACT: INTRODUCTION: 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. METHODS: Three hundred and forty six infected adults (age [greater than or equal to] 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analysed 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. RESULTS: 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 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. CONCLUSIONS: 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.
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