Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Incidental Capture of Chikungunya Associated Chronic Rheumatism along with Other Rheumatic Musculoskeletal Disorders in a Rural Community in South India: A BJD India WHO COPCORD (Community Oriented Program for Control of Rheumatic Diseases) Project.

Mathew3,  Ashish J., Goyal2,  Vinay, George2,  Elizabeth, Varughese2,  Dany, Antony2,  Jacob, Chopra1,  Arvind

BJD India Co-ordinator, Pune, India
The Trivandrum COPCORD Study Group
The Trivandrum COPCORD Study Group, Medical College Hospital and Health Action by People, Trivandrum, India.

Background:

Chikungunya (CHIKV) is a predominantly self limiting, severely painful, febrile, arboviral, musculoskeletal illness. Although post CHIKV chronic rheumatism is reported in <10% cases, prospective community data is sparse. In 2007, Kerala (a south Indian state) witnessed an unprecedented CHIKV epidemic. We present the burden of chronic rheumatic musculoskeletal disorders (RMSD) following the epidemic, captured inadvertently during a rural community survey (25 miles from Trivandrum, the state capital) in 2008.

Method:

An updated COPCORD Bhigwan (India) model (Chopra. J Rheumatol 2009; 36:614-22) questionnaires were used in a house-house survey to identify painful RMSD (last seven days) in a randomized population of 5133 adults. Respondents recorded pain sites on a human mannequin. Rheumatology physicians evaluated all cases. Diagnosis was clinical but often guided by the ACR criteria. We relied on typical narration, records and serology to classify CHIKV. A validated modified Indian Health Assessment Questionnaire (HAQ) - (Chopra. J Rheumatol 2000; 27:1365-72) was used to evaluate functional disability. Moderate and severe grades were considered significant.

Results:

Painful RMSD, the predominant self-reported ailment, was present in 30% of the community (Mean age of 53.24±15.3 years, 72% women). Common pain sites were knees (83.5%), elbows (36%), low back (31.1%) and shoulders (29.5%). Cases were broadly classified as ill-defined aches (28%), soft tissue rheumatism (21%), degenerative joint disease (20%), post-infectious arthropathy (19%), inflammatory arthritis (4%) and miscellaneous (8%). The crude point prevalence rates of RMSD are shown below.

Table 1. Crude prevalence rates of RMSD in each group

DiagnosesPrevalence (%)95% CI (%)
Soft tissue rheumatism10.139.3–10.96
    • Periarthritis shoulder2.161.83–2.49
    • Plantar fasciitis1.561.28–1.84
    • Fibromyalgia1.291.03–1.55
Degenerative arthropathy9.728.91–10.53
    • Knee OA5.775.23–6.31
    • Nodular OA1.851.54–2.16
Infection related arthropathy9.168.37–9.95
    • Post CHIK polyarthralgias5.735.2–6.26
    • Post CHIK reactive arthritis2.452.1–2.8
    • Post CHIK tenosynovitis0.950.73–1.17
Inflammatory arthritis1.791.43–2.15
    • Rheumatoid arthritis0.510.35–0.67
    • SSA0.580.41–0.75

CHIKV related RMSD was classified in 14% cases, of which 283 (Mean age: 45.64±11.37 years, 76% women) were naive for RMSD prior to the epidemic. Polyarticular onset (OR -4.35; 95% CI 2.77–6.83), wrist pain at onset (OR -4.23; 95% CI 2.62–6.45) and female sex (OR -2.747; 95% CI 1.76–4.28) were predictors of chronic rheumatism in this group. Similar to Bhigwan COPCORD the prevalence of RA and SSA was conspicuous. Significant HAQDI was scored by 17% respondents. Difficulty in the HAQ items of walking, squatting and sitting cross-legged corresponded with the dominant pain sites in knees and lower back. In the age group 25–54 years, 9% had ceased work due to RMSD.

Conclusion:

Though ill defined rheumatism remained the dominant category in this rural community, a wide spectrum of RMSD was observed. Such has been the conclusion of several COPCORD surveys. In the current study, CHIKV enhanced the community burden of RMSD. A long term follow up is warranted to study the future impact.

Funded by Bone and Joint Decade - India.

To cite this abstract, please use the following information:
Mathew, Ashish J., Goyal, Vinay, George, Elizabeth, Varughese, Dany, Antony, Jacob, Chopra, Arvind; Incidental Capture of Chikungunya Associated Chronic Rheumatism along with Other Rheumatic Musculoskeletal Disorders in a Rural Community in South India: A BJD India WHO COPCORD (Community Oriented Program for Control of Rheumatic Diseases) Project. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1549
DOI: 10.1002/art.29315

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