Is Methotrexate the Best Co-Treatment for Chronic Arthritis Associated With Chikungunya?

A new systematic review of published research suggests that methotrexate could potentially be the best co-treatment option for chronic arthritis associated with the chikungunya virus. The acute phase of the infection, also called chikungunya fever, often causes headaches, rashes, fevers, and, in some patients, inflammatory or persistent arthritis. After the acute phase, 59% of patients have chronic arthritis. The debilitating pain is similar to that of rheumatoid arthritis and can cause severe damage and destruction of the joints.

Kennedy Amaral, MD, an author of the study discussed the cause of the virus with Contagion®, saying, “The chikungunya virus spreads easily causing epidemics in places where the vector mosquito is present. A high percentage of infected people remain with chronic rheumatic symptoms and arthritis is the most disabling symptom.”

Conducted by Dr. Amaral, Robert Schoen, MD, and Ravi Sutaria, MD, the review focused on examining various treatment options for chronic arthritis associated with chikungunya. The investigators analyzed 131 studies including retrospective studies, prospective studies, and randomized trials that examined treatment options from NSAIDs to methotrexate and biological agents.

The investigators focused on 6 studies that used methotrexate, both alone and in combination with other treatments to treat chikungunya-related chronic arthritis. The studies were conducted in France, Martinique Island, and India. The investigators found that treatment options that included methotrexate were superior to options without. They posited that treatments with methotrexate were the most optimal because the chikungunya virus does not reside in the joints of patients suffering from chronic arthritis.

Although the number of available studies is limited, the investigators stated that, when taken together, the findings “demonstrate sufficient efficacy to justify interest in the treatment of chronic chikungunya arthritis with methotrexate.”

According to Dr. Amaral, “In spite of the limited data available, our systematic review supports our belief that methotrexate should receive further study for the treatment of chronic chikungunya arthritis. There is a need for larger scale, statistically rigorous, randomized prospective studies of methotrexate monotherapy, using quantifiable outcome measures.”