Manifestação articular crônica na chikungunya: revisão sistemática.

Abstract

Chikungunya is characterized by fever episodes associated with intense and debilitating joint pain, headache and myalgia. Although it presents with Dengue-like symptoms, the presence of polyarthritis/symmetric arthralgia (mainly affecting wrists, ankles and elbows), which usually improve after 10 days though may last for months after the fever episodes, calls attention. Prevalence rates of chronic cases varied throughout different epidemics in France, South Africa and islands of Indian Ocean, ranging from 4 to 63%. The emergence of arboviruses in previously inert locations stands as a potential public health challenge through many aspects. Aim: To observe the prevalence of chronic manifestations of Chikungunya in different countries over the world and comparing them. Methods: This study consisted of a systematic review of either prospective or retrospective cohort studies covering suspected Chikungunya patients, published in American, European, African and Asian countries, from 2006 up to 2017. Such studies were selected through MEDLINE, LILACS and Scielo databases, based on Virtual Health Library (VHL) search system. Initially, 327 studies were found, however after applying the inclusion and exclusion criteria, 7 articles were finally selected. Results: The present study included 1,348 participants who presented with Chikungunya diagnosis elucidated by PCR technique, ELISA or clinical criteria aging between 15 and 80 years, being mostly females. The time elapsed since the diagnosis of Chikungunya until the symptoms evaluation ranged from 1.5 to 27.5 months. Chikungunya prevalence was 15.84% (n=8,508) of the total sample of patients with suspected disease and the prevalence of chronic joint pain was 44.36% among patients with diagnosis confirmation (n=1,348). Conclusion: Most studies defined chronic disease as manifestations of disease after three months from the initial symptoms. The profile of patients with Chikungunya and chronic articular manifestations found in this review was compatible with the world literature. The prevalence of chronic arthralgia was higher in females. It was not possible to conclude whether previous joint disease or comorbidities were related to the increased chronicity of joint symptoms. Additionally, it was not possible to associate joint inflammation with the prolonged presence of the virus in the joint, as some studies suggest.