All you need to know about Chikungunya and the management of arthritis while affected by the disease

Chikungunya fever is a debilitating, but non-fatal, viral illness that has got Delhi in its grip at the moment. The illness is spread by the bite of infected female Aedes aegypti mosquito. Common symptoms of Chikungunya that develop 3-7 days after being bitten by an infected mosquito include fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash.
There is no need to panic since chikungunya is a non-fatal illness. Most patients suffering from it will feel better within a week. In some people however, the joint pain may persist for months. It is thus important to take necessary precautions against getting bitten by the Aedes mosquito known to cause both chikungunya and dengue fever. Those at high risk such as newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease need to be extra cautious since they can develop disease related complications, said Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.
Said in a joint statements Dr N K Yadav, Training Coordinator GDD-CDC Project, NIHFW New Delhi & Dr V K Monga, IMACGP, the Aedes mosquito breeds in clean water collections making it imperative to regularly water containers and tanks and check discarded material such as buckets, utensils, tyres, flowerpots etc for breeding. While the peak biting times of the Aedes aegypti mosquito are early morning or late evening, however the mosquito can also bite in the night when in a well-lit room making the use of mosquito repellents essential.
At present, there is no vaccine to prevent or medicine to treat chikungunya virus. Medicines can be used to ease symptoms. Patients are advised to get plenty of rest and drink fluids to prevent dehydration. It is important to note that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) should not be taken until dengue is ruled out to reduce the risk of bleeding since both the ailments present similar symptoms.
Given that joint pain is one of the primary symptoms of the disease, HCFI and IMA released a few points and tips on the management of arthritis in Chikenguniya:
* The osteoarticular problems seen with Chikungunya fever usually subside in one to two weeks’ time.
* In approximately 20% cases, they disappear after a gap of few weeks and in less than 10% cases, they tend to persist for months.
* In about 10 % cases, the swelling disappears; the pain subsides, but only to reappear with every other febrile illness for many months.
* Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever.
* Since an immunologic aetiology is suspected in chronic cases, a short course of steroids may be useful.
Care must be taken to monitor all adverse events and the drug should not be continued indefinitely to prevent adverse effects.
* Even though NSAIDS produce symptomatic relief in majority of individuals, care should be taken to avoid renal, gastrointestinal, cardiac and bone marrow toxicity.
* Cold compresses have been reported to lessen the joint symptoms.
* Disability due to Chikungunya fever arthritis can be assessed and monitored using one of the standard scales.
* Proper and timely physiotherapy will help patients with contractures and deformities.
* 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.
* Surgery may be indicated in severe and disabling contractures.
* 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.
* Occupational assistance after detailed disability assessment needs to be provided.

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