Saturday, 13 August 2016

Management of arthritis in Chikun Gunya

Management of arthritis in Chikun Gunya

Dr K K Aggarwal 1. The osteoarticular problems seen with Chikungunya fever usually subside in one to two weeks’ time. 2. In approximately 20% cases, they disappear after a gap of few weeks. 3. In less than 10% cases, they tend to persist for months. 4. In about 10 % cases, the swelling disappears; the pain subsides, but only to reappear with every other febrile illness for many months. 5. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. 6. Complement mediated damage and persistence of the virus in intra cellular sanctuaries have been implicated in occasional studies. 7. Destroyed metatarsal head has been observed in patients with persistent joint swelling. Management of osteoarticular manifestations follow the general guidelines given earlier. 8. Since an immunologic aetiology is suspected in chronic cases, a short course of steroids may be useful. 9. Care must be taken to monitor all adverse events and the drug should not be continued indefinitely to prevent adverse effects. 10. Even though NSAIDS produce symptomatic relief in majority of individuals, care should be taken to avoid renal, gastrointestinal, cardiac and bone marrow toxicity. 11. Cold compresses have been reported to lessen the joint symptoms. 12. Disability due to Chikungunya fever arthritis can be assessed and monitored using one of the standard scales. 13. Proper and timely physiotherapy will help patients with contractures and deformities. 14. Non weight bearing exercises may be suggested.; e. g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga etc. 15. Surgery may be indicated in severe and disabling contractures. 16. The management plan may be finalized in major hospitals, but the follow-up and long-term care must be done at a domiciliary or primary health centre level. 1. Occupational assistance after detailed disability assessment needs to be provided.

With inputs from Dr Rohini Handa

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