Dear Readers,

Several readers continue to be plagued by what they have understood to be a relapse of the chikungunya viral infection.They are concerned that they are still experiencing significant and persistent muscle and joint pains. Several individuals state that the relapse has been worse than the original viral infection and describe lingering joint pains most commonly in the elbows, hands, knees, and feet.

Lingering back pain that is not relieved by Panadol or other over-the-counter pain-relieving medications is also described. Often, swollen joints are also described.

joint disorders

As the facts concerning chik-V are researched, it becomes apparent that joint disorders due to chik-V infection can, and often do, persist for several months to years. A chronic arthritis after chik-V infection has been well documented in the medical literature, and similarities to rheumatoid arthritis have been described. Chronic musculoskeletal injury can be caused by persistent chik-V infection, and the acute phase chik-V infection is reported to often be followed by a long-lasting polyarthritis (joint pains). The mainstay of treatment for this includes non-steroidal anti-inflammatory drugs e.g. Voltaren, Nise, Cataflam, Zerodol, Arcoxia, etc, and other, stronger, disease modifying agents used in the treatment of rheumatoid arthritis.

The extended chik-V joint pains occur in two forms:

1) A continuous, prolonged lingering of painful joints;

2) Relapse attacks.

Both of these presentations of persisting joint pains are the hallmark of chikungunya rheumatism. chik-V can also trigger or reveal inflammatory rheumatic diseases such as rheumatoid arthritis or psoriatic arthritis. The chikungunya virus has been discovered to persist as a long-term viral presence in the liver, joints, and muscle tissues in some infected persons.

Independent indicators of the possibility of non-recovery from the chik-V muscle and joint infection and inflammation include:

The person being aged over 45 years. Advancing age is directly related to the severity and duration of chik-V joint symptoms.

Severe initial joint pain.

Underlying osteoarthritis.

Underlying co-morbidities. People with two or more other illnesses such as diabetes, hypertension, arthritis, and dyslipidemias are more likely to experience chronicity of joint pain.

Severe joint involvement at the initial, acute infection with six or more painful sites, as well as at least four other symptoms (e.g. fever, headache, swollen lymph glands, rash, itchy skin, swollen edematous limbs, etc) indicative of an initially more significant viral load. these persons are more likely to exhibit chronic chik-V arthritis.

lingering pain

Of even greater significance is the fact that 50 per cent of those infected with chik-V over the age of 45 years, statistically, have been found to still have lingering muscle and joint pains on an average of two years after the initial infection. Seri-negative spondylo-arthritis, soft-tissue rheumatism, osteoarthritis, and gout have all been reported to afflict chik-V sufferers.

What this means for our population is that there is another category of significant chronic arthritic pain to consider in both young and old who present with joint pains from this time forward. chik-V, in essence, will result in a chronic and persistent arthritic illness for a significant percentage of our population, at all ages - children to the elderly.

Treatment is available, but there is as yet, no vaccine or medication available to prevent or cure chik-V. Control of the vector, the Aedes Egypti mosquito, remains pivotal to preventing further spread of the illness in our communities, and we must all be our brother's keeper in keeping our communities clean permanently.

Send comments or questions to Lifeline: PO BOX 1731: KGN 8