America's North Shore Journal

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The Victims of Chikungunya

CHIKV pain

Over a year has passed since chikungunya swept across the Caribbean, and millions have contracted the mosquito borne illness. While most recovered after a miserable ten days, some patients continue to suffer joint pain. For a number of patients, the ongoing pain is nearly crippling.

We’ve reported in the past on the potential for this to occur. Lingering joint pain, arthralgia, is common. For some patients, it is constant while others experience period of remission and then a recurrence. Many report that the pain seems to settle into the sites of old, pre-illness, orthopedic injuries.

Tom Braak works with Faith in Action International in Verrettes, Haiti. In an exclusive e-mail interview, he talked about his illness.

I came down with chikungunya May 16 of last year. Had it bad for a couple months. Constant pain, at a much lesser level, continued until early December. Now I get pains on occasion, but nothing severe, more like bad arthritis I imagine. I’m 54, my wife, who is Haitian and 36 years old also had it. Not near as long, perhaps a month bad, and has mild occasional pains from it now. Ryan, our 5 year old son, had it for about two weeks. Like the rest of us, he has no residual pain.

Braak’s story echos many others. The younger the patient, the less likely it seems that there will be any lingering symptoms. While in Haiti, Braak tried Tylenol and ibuprofen for pain relief with no effect.

Cherries were in season at that time in Haiti. The family was drinking a lot of cherry juice and he noticed that it seemed to help his pain. The juice is believed to have some medicinal qualities and Mr. Braak notes that others who have tried the remedy seem to have experienced the same benefits.

In December, while in the United States, Mr. Braack saw a physician and received a non-steroidal anti-inflamatory. “That helped considerably. It may have been prednisone.”

Lindsay Downham is another American who contracted chikungunya in Haiti in May, 2014.

I’m 32 years old and I live in Haiti and I first got the virus last May and I still suffer with some lingering pain in wrists and hands almost daily.

Another patient who contracted chikungunya in Haiti is Laura. She became symptomatic about June 14, 2015.

… the night before I got the fever I had pain in a knee that had been giving me problems. The next morning it was excruciating. I sat down and it just got worse and worse.

Then around noon on the 15 I got the fever followed by the worst joint/bone pain in my whole body. There was no possible way to get comfortable. I could not walk at all. My husband had to put a bucket right next to my chair and lift me on to it just to pee. (We do not have running water and have to use an outhouse).

The fever lasted about 4 days. Then I got a full body rash. It was worse on my hands and feet. Rash was about 5 days with some days of a low grade fever.

Her pain has not disappeared. “The only joints that do NOT hurt in my body are my spine, right shoulder, and right elbow. All other joints hurt down to every toe bone.” She has tried natural oils, creams and rubs, with no relief. A prescription anti-inflammatory provided some relief for about a month. She continues to seek medical assistance and advice.

Marie Puccio also caught chikungunya. She is 29 and a volunteer in Haiti long term. “I have had chronic arthritis-like symptoms after getting it in June of last year.” Her rash and then the pain settled into recent injury sites.

… the rash localized on recent surgery sites and caused surgery healing complications

… a hurt ankle from a minor motorcycle accident took 6 months to fully heal when it should have taken a week

It’s a year later and my hands and feet are always swollen, I walk like an elderly person (particularly, just after waking up), and the exhaustion is relentless.

We do not know why some patients have the continuing pain. The long-term illness seems to mimic rheumatoid arthritis (RA) and some studies have shown that some patients met ACR criteria for seronegative RA.

A November 2014 article in The Rheumatologist has this to say about the treatment for chikungunya pain:

The mainstay of treatment in the acute phase is supportive measures with fluids and antiinflammatory agents (nonsteroidal antiinflammatory drugs [NSAIDs]).

There has been documentation of persistence of the virus in nonhuman primates weeks after infection …

Lindsay Lohan CHIKV painLindsay Lohan, the pop star, caught chikungunya in the South Pacific last December. She has has continuing pain since, but it is not clear if it is continuous or remitting. She has been touting “whole body cooling” for relief, an unproven and costly treatment.

A study published this month details the real world experience at an arthritis clinic in the Dominican Republic. They saw 514 patients with chikungunya-related musculoskeletal manifestations.

  1. 457.46 (89 %) exhibited very good clinical response to nonsteroidal anti-inflammatory drugs (NSAIDs)
  2. 370 (72 %) require low-dose steroids
  3. 5 patients (0.97 %) required methotrexate therapy
    1. The clinic also saw 53, of a total 328, existing rheumatoid arthritis patients who were on biological treatment and exhibited chikungunya-related musculoskeletal manifestations.

      Of most patients, 51/53 responded to NSAIDs, of which, 23 patients only responded partially, and in total 25 (47.1 %) required low-dose steroids. Disease-modifying antirheumatic drug (DMARD) therapy including biologics remained unchanged in this population.

      This study suggest the effectiveness of standard treatments for most patients with chikungunya joint pain. The course of treatment begins with nonsteroidal anti-inflammatory drugs and follows with low-dose steroids.

      At least one study is about to get underway. It will be looking at patients in Baranquilla, Colombia, where chikungunya is raging this summer. It is titled Chikungunya Arthritis in the Americas.

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