Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination. (July 2019) - Blettery, Marie
Highlights: Diagnosis of Chikungunya is based on the recognition of acute febrile joints manifestations. This can be difficult for people who are not used to examining joints or recognizing synovitis. Joint ultrasound has interest for diagnosis, prognosis and follow-up under treatment of joint diseases. As no studies are available, we carried out a systematic study of patients in the acute phase of the disease. We describe the aspects in the acute phase and note that not all painful joints are synovitis or effusion sites. Abstract: Objective: Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. Methods: Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinician — experienced in joint DUS — who also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. Results: In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. Conclusion: Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations.