Chikungunya: an emerging rheumatological pandemic?

Chikungunya virus (CHIKV) has recently emerged alongside Ebolavirus, Zika virus, and SARS-CoV-2 as the causative pathogen for a global pandemic. CHIKV is a single-stranded RNA alphavirus that is transmitted by Aedes species mosquitos and has spread beyond its endemic regions in East Africa and South Asia through the Indian Ocean islands, into Southern Europe, and through the Caribbean and the wider Americas. Acute chikungunya fever (CHIKF) is characterized by high fevers, arthralgias, myalgias, headaches, gastrointestinal disturbances, and maculopapular rash. Almost all patients recover from the acute illness, but up to fifty percent develop a chronic rheumatic syndrome with disabling arthritis that can last for months to years. Treatment of acute CHIKF is mainly supportive, while immunomodulation of chronic rheumatic disease with disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate appears to be beneficial. Preventive measures such as mosquito vector control and vaccination could decrease transmission and reduce the burden of chronic disabling post-viral arthritis.