Title:Chikungunya Arthritis Treatment with Methotrexate and
Dexamethasone: A Randomized, Double-blind, Placebo-controlled Trial
Volume: 20
Issue: 3
Author(s): José Kennedy Amaral*, Gabriela Lucena and Robert Taylor Schoen
Affiliation:
- Department of Rheumatology, Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Ceará, Brazil
Keywords:
Chikungunya, methotrexate, arthritis, dexamethasone, virus, DMARD.
Abstract:
Background: Chikungunya fever is a reemerging epidemic disease caused by a single-stranded
RNA alphavirus transmitted throughout by Aedes mosquitoes. Chikungunya virus infection
is a biphasic disease in which 72% to 95% of affected individuals manifest acute chikungunya
fever. Following the acute phase, more than 40% of affected individuals develop arthritis, often
lasting more than 3 months, referred to as chronic chikungunya arthritis, which frequently mimics
rheumatoid arthritis.
Objective: This study aimed to evaluate the efficacy and safety of treatment of chronic chikungunya
arthritis with methotrexate and dexamethasone in a randomized, double-blind, placebo-controlled
clinical trial.
Methods: The patients were reassessed for treatment response by the DAS28-ESR, tender joint
count and swollen joint count, Patient Global Assessment, and for secondary measures, including
the Health Assessment Questionnaire Disability Index and Pain Visual Analog Scale.
Results: Thirty-one subjects were randomized (placebo, n = 16; methotrexate, n = 15); 27 completed
treatment and 4 discontinued during the 8-week blinded period. Among the participants, 96.8%
were female, with mean ± SD age was 52.9 ± 13. The mean ± SD disease duration prior to treatment
was 220.9 ± 51.2 days. At 8 weeks, methotrexate-treated subjects showed a greater numerical
trend towards improvement, but there were no significant differences between methotrexate-
dexamethasone group and dexamethasone (placebo) group.
Conclusion: In this relatively small cohort, all of whom received background dexamethasone,
there was a greater numerical improvement trend in prespecified outcome measures, but
methotrexate in combination with dexamethasone was not superior to dexamethasone in chronic
chikungunya arthritis.
