Chronic musculoskeletal (MSK) symptoms such as arthralgia and arthritis develop in up to half of patients after acute chikungunya virus (CHIKV) infection. While MSK complaints are common during the acute infection, chronic post-CHIKV rheumatism represents a more severe outcome and is usually assessed by joint counts, laboratory markers and patient-reported outcomes (PROs). Ultrasound (US) may be a practical tool for predicting and confirming the development of chronic CHIKV.
Objectives
To evaluate the clinical relevance of MSKUS findings in post-chikungunya rheumatism.
Methods
80 patients with acute CHIKV infection were enrolled in a prospective cohort study in Jaén, Peru. Clinical exam, US scans using grey-scale and power Doppler (PDUS), and serum inflammatory markers were performed at inclusion and at 3-month follow-up. Patients completed the RAPID3 outcome assessment and a MSK stiffness questionnaire. Joint counts and PDUS scans included 20 pairs of joints. Global synovitis and tenosynovitis scores were calculated following the EULAR-OMERACT recommendations for rheumatoid arthritis (GLOESS).
Results
59 patients (mean age 35 years, 68% female) were assessed both in the acute infection stage and at 3-month follow-up. 21 patients (35%) met strict criteria for defining chronic CHIKV rheumatism with a mean 4.4 (±2.2) tender joints and RAPID3 scores >6. In the acute infection phase, global PDUS synovitis and tenosynovitis scores correlated moderately with tender joint count and with pain severity, joint stiffness and RAPID3 scores, but were not strongly predictive of patients who went on to develop chronic arthralgia. After 3 months, global PDUS synovitis scores correlated more strongly with tender joint count (r=0.53, p<0.0001), pain severity (r=0.60, p<0.0001), joint stiffness (r=0.53, p<0.0001) and RAPID3 scores (r=0.60, p<0.0001) (Table 1).
Conclusion
Global PDUS synovitis and tenosynovitis scores may be an objective measure of disease severity in patients developing chronic CHIKV rheumatism. Further validation with longer-term follow-up is needed.
REFERENCES:
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Acknowledgements:
NIL.
Disclosure of Interests
Hugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Evotec, Juana del Valle Mendoza Grant/research support from: Sanofi, Evotec, Wilmer Silva Caso Grant/research support from: Sanofi, Evotec, Miguel Aguilar Luis Grant/research support from: Sanofi, Evotec, Andrea NIzzardo Employee of: Evotec, Giulia Calusi Employee of: Evotec, Marie Mandron Employee of: Sanofi, Evotec, Maria-Antonietta D'Agostino Consultant of: Evotec.
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia (FM) has progressed remarkably in recent years. Despite this, currents accounts of FM fail to capture the complex, dynamic and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to synthesise current knowledge on FM, explore and highlight multi-level links and pathways among different systems and build bridges between existing approaches. An extensive panel of international experts in neurophysiology and psychosocial aspects of FM discussed the collected evidence and progressively refined and conceptualized its interpretation. Fibromyalgia is a complex condition resulting from the dynamic interplay between multiple systems and processes. We provided an updated overview of the most relevant observations in FM to date as well as the potential pathways by which they exert they are related and exert their mutual influence, to produce the manifestations commonly associated with FM. This review constituted the first step towards and supported the development of a much needed model capable of integrating the main factors implicated in FM into a single, unified model that may prove valuable in understanding and managing FM.
The EULAR/ERA-EDTA recommendations for lupus nephritis state that renal response should be achieved in 12 months following induction therapy. However, early predictors of renal outcome are not well established. We aim to identify baseline predictors of complete renal response (CRR).
Methods
Retrospective cohort study over 36 months including patients with SLE fulfilling the ACR'97 and/or the SLICC'12 classification criteria and with a biopsy-proven proliferative lupus nephritis (class III/IV), enrolled in the CHUC Lupus Cohort. CCR was defined according to EULAR/ERA-EDTA definitions as proteinuria <0.5 g/day and normal renal function. Clinical-demographic characteristics at baseline were compared using survival analysis for time-to-CCR. Variables with p<0.25 on univariate analysis with Log-Rank tests and lupus nephritis histological class (III/IV) were further evaluated as potential predictors with multivariate Cox proportional hazards regression models (Backward Stepwise method) adjusting for potential confounding.
Results
56 patients were included in the analysis (76.8% female, age at baseline 30.0 ± 13.2 years-old). Over the follow-up period, 51 patients (91.1%) reached CCR, within a median time of 6.0 months. High blood pressure (p=0.047), no hydroxychloroquine therapy (p=0.012), induction treatment with cyclophosphamide (as compared to mycophenolate mofetil - MMF) (p=0.027) and proteinuria >2 g/day (p=0.008) were associated with longer time to CCR in univariate analysis. In multivariate analysis, proteinuria >2 g/day at baseline (HR 2.651; 95%CI 1.338–5.25; p=0.005) was a predictor of worse renal outcome, while induction therapy with MMF lead to shorter time to CCR as compared with cyclophosphamide (HR=0.525; 95%CI 0.277–0.998; p=0.049). Other variables lost significance and were not included in the final model. The addition of glucocorticoid pulses and/or antihypertensive drugs to induction therapy did not influence renal outcome.
Conclusions
Most of the patients reached CCR during the follow-up period. Proteinuria above 2 g/day at baseline and use of cyclophosphamide as compared to MMF induction were associated with worse renal outcome.
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