Chikungunya and Rheumatoid Arthritis: Differentiating Chronic Polyarthralgia and Rheumatological Markers

Chikungunya and rheumatoid arthritis (RA) are two conditions that can present with chronic polyarthralgia, but their origins and underlying mechanisms are notably different. Chikungunya is an epidemic fever caused by a virus transmitted by mosquitoes of the genus Aedes, while rheumatoid arthritis is a chronic autoimmune disease. Despite their differences, both can manifest with persistent joint symptoms that challenge differential diagnosis.

Diving Deeper into Differentiation

Chikungunya is characterized by an acute onset of fever, rash, and severe arthralgia. Although acute symptoms typically resolve within weeks, a significant percentage of patients experience chronic arthralgia that can last for months or even years. This chronic joint pain often resembles that of rheumatoid arthritis, complicating the differential diagnosis. Studies have shown that the persistence of the virus in monocytes-macrophages and the activation of osteoclasts through the RANK/RANKL pathway may contribute to chronic inflammation and prolonged joint pain (Chikungunya-Driven Gene Expression).

On the other hand, rheumatoid arthritis is an autoimmune disease characterized by symmetrical joint inflammation, morning stiffness, and the presence of rheumatological markers such as rheumatoid factor and anti-CCP antibodies. Unlike chikungunya, RA is not associated with a viral infection but rather with a dysfunction of the immune system that attacks the body's own joints.

A study conducted in Japan highlighted the importance of considering chikungunya in the differential diagnosis of patients with chronic arthritis who have traveled to endemic areas, as the presence of rheumatoid factors can confuse the diagnosis (Chikungunya Fever in Japan).

Conclusions

The differentiation between chikungunya and rheumatoid arthritis is crucial for the appropriate management of patients with chronic polyarthralgia. While chikungunya may be self-limiting, RA requires long-term immunomodulatory treatment. The identification of rheumatological markers and a detailed clinical history, including travel to endemic areas, are essential for accurate diagnosis. Ongoing research into the molecular mechanisms of chikungunya could offer new therapeutic strategies for managing its chronic symptoms.

Referencias

• [1] Chikungunya: A rheumatologist's perspective
• [2] Prevalence of and risk factors for chronic arthralgia and rheumatoid-like polyarthritis more than 2 years after infection with chikungunya virus
• [3] Chikungunya-Driven Gene Expression Linked to Osteoclast Survival and Chronic Arthralgia
• [4] Chikungunya Fever in Japan Imported from the Caribbean Islands

Created 6/1/2025