Don't Confuse Chikungunya and Arthritis
Image Attribution

Image Attribution

Author: Christopher Macsurak
Source: Lindsay Lohan at Cynthia Rowley
URL: http://commons.wikimedia.org/wiki/File%3ALindsay_Lohan_at_Cynthia_Rowley_2011.jpg
License: Creative Commons Attribution 2.0 Generic

Who knew Lindsay Lohan could help educate the public about a serious disease?

The actress has been using social media to get the word out about chikungunya, the virus she recently contracted while traveling.

“In good faith with good people. I refuse to let a virus effect (sic) my peaceful vacation,” she captioned an Instagram photo in January.

It’s probably good Lohan is keeping a positive attitude, but don’t let her glamorous posts fool you: Chikungunya can have serious and lasting symptoms — many of which closely mimic rheumatoid arthritis (RA).

Symptoms of the RNA virus chikungunya include joint pain, muscle pain, fever, headache, nausea, fatigue, rashes, and general malaise.

The joint pain is typically severe and can vary in location and duration. These symptoms are all hallmarks of RA and other rheumatic diseases, too.

However, unlike these conditions, these symptoms are usually not permanent in a person with chikungunya.

mosquito

Many U.S. patients with chikungunya contract the illness while traveling, particularly in a tropical locale. Chikungunya is transmitted by the bite of a mosquito that is infected with the virus.

According to the World Health Organization (WHO), it is prevalent in Asia, Africa, and the Indian subcontinent. However, not all instances of chikungunya are due to overseas travel. In fact, the condition is becoming a more pressing concern in Florida and other southern states.

How Do I Know If It Is RA or Chikungunya?

Since chikungunya so closely mimics rheumatoid arthritis, it may be easy to confuse the two. A doctor has to be aware of the possibility of both conditions when running tests in order to make a proper diagnosis. A physical exam and patient health history are crucial components to evaluating someone for either chikungunya or RA.

 “Given the chikungunya virus is not endemic to the northern United States, a history of recent travel is important in making the diagnosis. On the other hand, a family history of rheumatoid arthritis or other rheumatologic diseases may be more suggestive of RA,” says Dr. Adam Dore, a rheumatologist with the Allegheny Health Network in Pittsburgh.

“Chikungunya symptoms can develop very rapidly whereas RA often develops more insidiously.”
Dr. Adam Dore, Allegheny Health Network

He cautions it is also important for doctors to note how quickly the disease symptoms presented themselves in order to make a proper diagnosis.

“The rapidity of symptom onset can also be helpful. Chikungunya symptoms can develop very rapidly (overnight), whereas RA often develops more insidiously (weeks to months),” said Dore.

Which joints are affected is also a part of the puzzle when ruling out chikungunya. “On physical exams, both conditions can have swelling of and around the joints. However, the chikungunya virus tends to affect more large joints, such as the knee, as opposed to RA, which more commonly affects the joints of the hands and feet initially.”

Read more: Chikungunya Outbreak Likely in U.S., Say Experts »

Dr. M. Elaine Husni, director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic’s Orthopaedic and Rheumatologic Institute, said symptoms can be a key in telling the difference.

“On exams, patients with RA have specific joints affected with swelling most prominent in a symmetric pattern of both hands, wrists, or feet, with stiffness worse in the morning with a more insidious onset,” she said. “There is more diffuse, widespread joint and muscle pain with chikungunya that occurs more abruptly with high fevers, feeling unwell, nausea, and rash. The joint pain often ends in a few days or weeks and only rarely persists for months or years.”

Will Contracting Chikungunya Mean I’m at Risk for RA?

Some patients may believe contracting chikungunya will put them at a higher risk for conditions like rheumatoid arthritis or lupus. While most evidence indicates this is not the case, it is unclear if the joint pain and other RA-like symptoms of chikungunya could in some cases become permanent, let alone morph into a disease like RA.

“There has not been conclusive evidence that the chikungunya infection is in association with developing RA or other autoimmune diseases. There is an entity whereby infections such as gastrointestinal illness can cause reactive arthritis. However, this is not specific to chikungunya but to having certain infections,” explained Husni.

Read more: ‘Kissing Bug’ Disease, Chikungunya, and Dengue Arrive in U.S. Amid Hotter Temperatures »

Some doctors do feel there is a chance of chikungunya joint pain becoming more permanent.

Dr. Joan Bathon, director of the Division of Rheumatology at New York-Presbyterian Hospital/Columbia University Medical Center said, “I am not aware of data showing that chikungunya is a risk factor for developing RA. However, the arthritis of chikungunya can become chronic and can be confused with RA.”

She notes that fast-acting, chikungunya-specific blood tests are crucial since RA is often a more difficult diagnosis to make immediately.

“There is a specific test for chikungunya that, at least in New York, comes back fairly rapidly. If a state health department doesn't have the test, it can go to the Centers for Disease Control and Prevention (CDC) in Atlanta,” she said. “There are also two different tests that aid in the diagnosis of rheumatoid arthritis. So, using clinical judgment and use of these diagnostic tests, the two types of arthritis are distinguishable. But the physician has to think of chikungunya first.”

How Can I Prevent Chikungunya?

Chikungunya is difficult to prevent. The only real way to ensure you won’t get the virus is to avoid mosquito bites — a feat often easier said than done. The CDC does offer some tips on how to do so.

RA, on the other hand, is impossible to prevent. Early diagnosis, the reduction of risk factors, and proper self-care and disease management are some tools to help avoid or prolong the debilitating joint damage that can come along with it.

Read more: RA: Joint Pain Remedies from Around the World»