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Rheumatology272 papers

Chikungunya fever

Last edited: 4/14/2026

Overview

Chikungunya fever is a re-emerging arboviral disease caused by the Chikungunya virus (CHIKV), characterized by acute febrile syndrome often progressing to chronic articular manifestations affecting long-term quality of life 2.

Diagnosis

  • Clinical Criteria: Fever, arthralgia, and rash are typical 12.
  • Laboratory Tests: Serological tests (IgM/IgG antibodies) for CHIKV confirmation 14.
  • Imaging/Special Tests: Not routinely required but may include musculoskeletal imaging for persistent arthropathy 13.

    • Management

  • First-Line Treatments:
    • - Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1315. - Corticosteroids may be considered for severe cases but with caution due to potential complications 15.
  • Adjunctive Treatments:
    • - Hydroxychloroquine and methotrexate have been explored for chronic arthritis, though evidence is limited 15. - Physical therapy and rehabilitation to manage functional impairment 13.

    Special Populations

  • Elderly: Increased risk of severe adverse events with live-attenuated vaccines (IXCHIQ); caution advised, especially for those ≥65 years 45.
  • Comorbidities: Specific management adjustments may be necessary based on underlying conditions, though detailed guidelines are limited 15.

    • Key Recommendations

  • Vaccination Precautions for Older Adults: Avoid or use caution with live-attenuated CHIKV vaccines in individuals ≥65 years due to increased risk of severe adverse events (Evidence: Moderate 45).
  • Use of NSAIDs for Symptomatic Relief: Employ NSAIDs as first-line treatment for pain and inflammation in acute and chronic phases (Evidence: Expert opinion 1315).
  • Multidisciplinary Approach for Chronic Arthralgia: Implement combined rheumatology and tropical diseases services for comprehensive management of persistent arthralgia (Evidence: Expert opinion 7).

    • References

    1 Chandrashekhar V. Side effects dim hopes for first chikungunya vaccine. Science (New York, N.Y.) 2026. link 2 Hakim MS. Reverse vaccinology-based design of a universal multiepitope vaccine against chikungunya virus: Phylogenetic and immunoinformatics approaches. Scientific reports 2026. link 3 Hills SL, Shlim DR, Schofield S, Wilson ME, Barnett ED, Chen LH et al.. Chikungunya vaccination for travellers: practical guidance for clinical decision-making. Journal of travel medicine 2025. link 4 Simone B, Lienert F. Post-authorisation experience and reported adverse events following use of a virus-like particle chikungunya vaccine, United States and Germany, up to August 2025. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2025. link 5 Hills SL, Sutter RA, Miller ER, Asturias EJ, Chen LH, Bell BP et al.. Surveillance for adverse events following use of live attenuated chikungunya vaccine, United States, 2024, and the associated public health response in 2024 and 2025. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2025. link 6 da Costa VG, Saivish MV, Sinhorini PF, Nogueira ML, Rahal P. A meta-analysis of Chikungunya virus in neurological disorders. Infectious diseases now 2024. link 7 Krutikov M, Donovan J, Lambourne J, Ciurtin C, Brown M, Bailey R et al.. The Development and Evaluation of a Combined Infection-Rheumatology Assessment Service in Response to the Chikungunya Fever Epidemic. The American journal of tropical medicine and hygiene 2023. link 8 Machado MC, Moraes LA, Maia TR, Ferreira JLM, Cavalcanti LPG, Rodriguez PJY. Profile of Chikungunya Patients with Ophthalmological Manifestations in a Reference Center in Brazil. Japanese journal of infectious diseases 2023. link 9 Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC et al.. Musculoskeletal disorders due to chikungunya virus: A real experience in a rheumatology department in Neiva, Huila. Reumatologia clinica 2021. link 10 Brito CAA, Marques CDL, Falcão MB, Cunha RVD, Simon F, Valadares LDA et al.. Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline. Revista da Sociedade Brasileira de Medicina Tropical 2020. link 11 Monge P, Vega JM, Sapag AM, Moreno I, Montúfar R, Khoury V et al.. Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2019. link 12 Ferreira AC, Reis PA, de Freitas CS, Sacramento CQ, Villas Bôas Hoelz L, Bastos MM et al.. Beyond Members of the . Antimicrobial agents and chemotherapy 2019. link 13 Kennedy Amaral Pereira J, Schoen RT. Management of chikungunya arthritis. Clinical rheumatology 2017. link 14 Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG et al.. Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations. Revista brasileira de reumatologia 2017. link 15 Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG et al.. Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment. Revista brasileira de reumatologia 2017. link 16 Pineda C, Muñoz-Louis R, Caballero-Uribe CV, Viasus D. Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems. Clinical rheumatology 2016. link

    Original source

    1. [1]
      Side effects dim hopes for first chikungunya vaccine. — Chandrashekhar V Science (New York, N.Y.) (2026)
    2. [2]
      Reverse vaccinology-based design of a universal multiepitope vaccine against chikungunya virus: Phylogenetic and immunoinformatics approaches. — Hakim MS Scientific reports (2026)
    3. [3]
      Chikungunya vaccination for travellers: practical guidance for clinical decision-making. — Hills SL, Shlim DR, Schofield S, Wilson ME, Barnett ED, Chen LH et al. Journal of travel medicine (2025)
    4. [4]
      Post-authorisation experience and reported adverse events following use of a virus-like particle chikungunya vaccine, United States and Germany, up to August 2025. — Simone B, Lienert F Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2025)
    5. [5]
      Surveillance for adverse events following use of live attenuated chikungunya vaccine, United States, 2024, and the associated public health response in 2024 and 2025. — Hills SL, Sutter RA, Miller ER, Asturias EJ, Chen LH, Bell BP et al. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin (2025)
    6. [6]
      A meta-analysis of Chikungunya virus in neurological disorders. — da Costa VG, Saivish MV, Sinhorini PF, Nogueira ML, Rahal P Infectious diseases now (2024)
    7. [7]
      The Development and Evaluation of a Combined Infection-Rheumatology Assessment Service in Response to the Chikungunya Fever Epidemic. — Krutikov M, Donovan J, Lambourne J, Ciurtin C, Brown M, Bailey R et al. The American journal of tropical medicine and hygiene (2023)
    8. [8]
      Profile of Chikungunya Patients with Ophthalmological Manifestations in a Reference Center in Brazil. — Machado MC, Moraes LA, Maia TR, Ferreira JLM, Cavalcanti LPG, Rodriguez PJY Japanese journal of infectious diseases (2023)
    9. [9]
      Musculoskeletal disorders due to chikungunya virus: A real experience in a rheumatology department in Neiva, Huila. — Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC et al. Reumatologia clinica (2021)
    10. [10]
      Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline. — Brito CAA, Marques CDL, Falcão MB, Cunha RVD, Simon F, Valadares LDA et al. Revista da Sociedade Brasileira de Medicina Tropical (2020)
    11. [11]
      Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America. — Monge P, Vega JM, Sapag AM, Moreno I, Montúfar R, Khoury V et al. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases (2019)
    12. [12]
      Beyond Members of the — Ferreira AC, Reis PA, de Freitas CS, Sacramento CQ, Villas Bôas Hoelz L, Bastos MM et al. Antimicrobial agents and chemotherapy (2019)
    13. [13]
      Management of chikungunya arthritis. — Kennedy Amaral Pereira J, Schoen RT Clinical rheumatology (2017)
    14. [14]
      Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations. — Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG et al. Revista brasileira de reumatologia (2017)
    15. [15]
      Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment. — Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG et al. Revista brasileira de reumatologia (2017)
    16. [16]
      Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems. — Pineda C, Muñoz-Louis R, Caballero-Uribe CV, Viasus D Clinical rheumatology (2016)
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