The challenges of chikungunya arthropathy

Chikungunya virus (CHIKV) can cause an array of acute and chronic rheumatic manifestations, including chikungunya arthropathy, and remains a global problem. The 2004-2019 epidemic of CHIKV has provided valuable insights that could inform the development of therapeutic and preventative strategies.

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Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes an array of different symptoms, most notably fever and severe joint pain. For some patients, rheumatic manifestations of chikungunya can persist for months or even years. Prior to 2004, CHIKV was endemic to Africa and Asia. However, since an initial outbreak on Lamu Island in 2004, CHIKV has emerged as a global pathogen, spreading across the globe and causing periodic outbreaks in Europe and the Americas. Chikungunya remains a global issue: in a recent outbreak in September 2019 in Ethiopia, ~20,000 individuals are thought to have contracted this disease. 

A Review article published in Nature Reviews Rheumatology by Andreas Suhrbier summarizes the lessons learnt in the aftermath of the 2004-2019 CHIKV epidemic. He outlines the various disease manifestations of chikungunya, including those associated with acute, atypical and severe acute disease, as well as chronic disease. He also discusses new insights in the immunopathology and treatment of chikungunya arthralgia, and emerging therapeutic and preventative strategies.

Use of insecticides, the cornerstone strategy for controlling mosquitoes, is hampered by the resurgence of insecticide resistance. Alternative methods for controlling mosquitoes and viral transmission of CHIKV are being tested. Notably, funding is now in place for a phase III trial of what could be the first chikungunya vaccine. 

Better treatment options are needed for patients with chikungunya, including those patients with NSAID-refractory arthropathy, chronic arthralgia or severe disease. Preclinical and clinical investigations of drugs (both new and repurposed) for the treatment of chikungunya arthropathy are underway. Further research is needed to elucidate the mechanisms underlying chikungunya arthropathy, which could open up new therapeutic avenues. 

Jessica McHugh

Senior Editor, Nature Reviews Rheumatology

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