From the Guidelines
Chikungunya symptoms can persist or recur in some individuals, particularly in the form of chronic joint pain, which can last for months or even years after the initial infection. This is not a true recurrence of the virus, but rather a continuation of symptoms due to the body's inflammatory response to the initial infection, as suggested by studies on the long-term outcomes of Chikungunya infections 1. The acute phase of chikungunya usually lasts about a week, characterized by sudden onset of fever and severe joint pain. After this, most people recover fully. However, up to 30-40% of individuals may develop chronic joint pain that can last for extended periods, with some studies indicating that only four in ten adults had an apparent full recovery three years after discharge 1.
Some key points to consider about Chikungunya symptoms include:
- The virus does not establish latency in the body like some other viruses (e.g., herpes viruses) that can reactivate, suggesting that true recurrences are unlikely 1.
- If someone experiences chikungunya-like symptoms again after a full recovery, it's more likely to be a new infection with a different mosquito-borne virus or another cause entirely, rather than a recurrence of chikungunya.
- Management of chronic symptoms typically involves pain relief medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and rest, with disease-modifying antirheumatic drugs (DMARDs) prescribed in severe cases to manage persistent joint inflammation.
- Prevention through mosquito control measures remains crucial, as there is no specific antiviral treatment for chikungunya, and outbreaks can have significant neurological and other complications, particularly in vulnerable populations such as infants and adults over 60 years 1.
From the Research
Chikungunya Symptoms Recurrence
- Chikungunya symptoms can recur, with approximately 50% of infected people developing chronic symptoms lasting for months or years 2.
- Joint involvement is the main clinical manifestation of Chikungunya, characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease 2.
- A study of 307 patients with 32-month follow-up found that joint pain persisted in 83.1% of the patients, with functional impairment being moderate 3.
- Another study found that inflammatory joint symptoms persisted in 17/30 patients after 13 years, highlighting the long-term Chikungunya-related patient burden 4.
- A systematic review of controlled clinical trials found that available evidence does not show any added benefit of certain pharmacological interventions compared with anti-inflammatory drugs or placebo/no treatment, and non-steroidal anti-inflammatory drugs may reduce pain up to 24 weeks of treatment but long-term residual impact after stopping treatment is unassessed 5.
- A study of 120 patients found that chronic joint pain and stiffness 3 years after Chikungunya virus infection was largely characterized by relapsing-remitting symptoms, with 1 out of every 8 people who tested serologically positive for Chikungunya infection having persistent joint pain 3 years after infection 6.
Characteristics of Recurring Symptoms
- The most common type of pain reported in patients with recurring symptoms is pain with periods of relief and subsequent reoccurrence 6.
- Over 75% of patients with recurring symptoms reported stiffness after immobility, with 39% experiencing morning stiffness 6.
- Chikungunya-related chronic inflammatory rheumatic diseases can persist for several months or even several years, with some cases resembling those usually associated with rheumatoid arthritis 3, 4.