Limits...
Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study.

Gérardin P, Fianu A, Michault A, Mussard C, Boussaïd K, Rollot O, Grivard P, Kassab S, Bouquillard E, Borgherini G, Gaüzère BA, Malvy D, Bréart G, Favier F - Arthritis Res. Ther. (2013)

Bottom Line: Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection.Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R.By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R.

Methods: Three hundred and forty-six infected adults (age≥15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis.

Results: Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms.

Conclusions: Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

Show MeSH

Related in: MedlinePlus

Prognostic survey participation profile. RMSP, rheumatic musculoskeletal pain. The prognostic survey cohort sample was issued from the TELECHIK survey, a population-based cohort study (November 2007 to May 2008) (23). After elimination of 582 Chikungunya virus (CHIKV)-seronegative subjects and 90 subjects not presenting with RMSP at disease onset, 76 subjects were excluded (50 children, 15 adults for relocations and absence of contact, 11 for the absence of overt temporality in the clinical course of Chikungunya rheumatism), leaving 346 eligible adult participants assessed on the course of RMSP. This population was shifted towards the selection of more women and older participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672753&req=5

Figure 1: Prognostic survey participation profile. RMSP, rheumatic musculoskeletal pain. The prognostic survey cohort sample was issued from the TELECHIK survey, a population-based cohort study (November 2007 to May 2008) (23). After elimination of 582 Chikungunya virus (CHIKV)-seronegative subjects and 90 subjects not presenting with RMSP at disease onset, 76 subjects were excluded (50 children, 15 adults for relocations and absence of contact, 11 for the absence of overt temporality in the clinical course of Chikungunya rheumatism), leaving 346 eligible adult participants assessed on the course of RMSP. This population was shifted towards the selection of more women and older participants.

Mentions: This study involved a subsample of the SEROCHIK and TELECHIK studies. Both studies have been reviewed extensively elsewhere [24,25]. The frame of the participant selection is given in Figure 1 and Additional file 1. Seroprevalence estimates have been measured on average 7.6 months (range 1 to 18 months) following acute infection for each individual, which time point was assumed to correspond to the plateau phase of the production of individual-specific-IgG and to the crucial time of evolvement to either recovery or the chronic phase. The TELECHIK study has been conducted in the framework of the SEROCHIK study between December 2007 and June 2008, on average eighteen months after the fall of the outbreak. In this study, the exposure to CHIKV was confirmed by CHIKV-specific IgG ELISA antibodies [24].


Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study.

Gérardin P, Fianu A, Michault A, Mussard C, Boussaïd K, Rollot O, Grivard P, Kassab S, Bouquillard E, Borgherini G, Gaüzère BA, Malvy D, Bréart G, Favier F - Arthritis Res. Ther. (2013)

Prognostic survey participation profile. RMSP, rheumatic musculoskeletal pain. The prognostic survey cohort sample was issued from the TELECHIK survey, a population-based cohort study (November 2007 to May 2008) (23). After elimination of 582 Chikungunya virus (CHIKV)-seronegative subjects and 90 subjects not presenting with RMSP at disease onset, 76 subjects were excluded (50 children, 15 adults for relocations and absence of contact, 11 for the absence of overt temporality in the clinical course of Chikungunya rheumatism), leaving 346 eligible adult participants assessed on the course of RMSP. This population was shifted towards the selection of more women and older participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672753&req=5

Figure 1: Prognostic survey participation profile. RMSP, rheumatic musculoskeletal pain. The prognostic survey cohort sample was issued from the TELECHIK survey, a population-based cohort study (November 2007 to May 2008) (23). After elimination of 582 Chikungunya virus (CHIKV)-seronegative subjects and 90 subjects not presenting with RMSP at disease onset, 76 subjects were excluded (50 children, 15 adults for relocations and absence of contact, 11 for the absence of overt temporality in the clinical course of Chikungunya rheumatism), leaving 346 eligible adult participants assessed on the course of RMSP. This population was shifted towards the selection of more women and older participants.
Mentions: This study involved a subsample of the SEROCHIK and TELECHIK studies. Both studies have been reviewed extensively elsewhere [24,25]. The frame of the participant selection is given in Figure 1 and Additional file 1. Seroprevalence estimates have been measured on average 7.6 months (range 1 to 18 months) following acute infection for each individual, which time point was assumed to correspond to the plateau phase of the production of individual-specific-IgG and to the crucial time of evolvement to either recovery or the chronic phase. The TELECHIK study has been conducted in the framework of the SEROCHIK study between December 2007 and June 2008, on average eighteen months after the fall of the outbreak. In this study, the exposure to CHIKV was confirmed by CHIKV-specific IgG ELISA antibodies [24].

Bottom Line: Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection.Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R.By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R.

Methods: Three hundred and forty-six infected adults (age≥15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis.

Results: Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms.

Conclusions: Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

Show MeSH
Related in: MedlinePlus