Published online Jun 25, 2024. doi: 10.5501/wjv.v13.i2.89985
Revised: February 9, 2024
Accepted: April 12, 2024
Published online: June 25, 2024
Processing time: 216 Days and 19.8 Hours
Chikungunya fever (CF) is caused by an arbovirus whose manifestations are extremely diverse, and it has evolved with significant severity in recent years. The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses. Generally, fever starts abruptly and reaches high levels, followed by severe polyarthralgia and myalgia, as well as an erythematous or petechial maculopapular rash, varying in severity and extent. Around 40% to 60% of affected individuals report persistent arthralgia, which can last from months to years. The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system. The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Β ligand and bone resorption. This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages, leading to local infiltration of CD4+ T cells, which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines. The term "long chikungunya" was used in this review to refer to persistent arthralgia since, due to its manifestation over long periods after the end of the viral infection, this clinical condition seems to be characterized more as a sequel than as a symptom, given that there is no active infection involved.
Core ip: This review of Chikungunya fever focuses on one of the most prevalent and important symptoms of the disease-arthralgia. The authors propose an approach to explain the persistence of arthralgia for a long time after the resolution of the infection, based on the sustained inflammatory response, mainly by macrophages and T helper type 17 cells. Additionally, it is suggested that, given the context, persistent arthralgia is a sequel of CF and could therefore be termed "long Chikun-gunya".