Letter to the Editor
Response to: Tropical Arthritogenic Alphaviruses
Respuesta a: Alfavirus tropicales artritogénicos
a Grupo y Semillero de Investigación Salud Pública e Infección, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
b Centro de Estudio de Enfermedades Autoinmunes (CREA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Rodríguez-Morales, Jorge A. Sánchez-Duque, Juan-Manuel Anaya" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Alfonso J." "apellidos" => "Rodríguez-Morales" "email" => array:1 [ 0 => "arodriguezm@utp.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jorge A." 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They have been classified into 4 groups, A, B, C and D, the first 2 being of greater clinical importance.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Group A is comprised of the genus alphavirus, involving Chikungunya virus and Mayaro virus, both arthritogenic; whereas group B includes other tropical arthritogenic viruses of other genera and families, also of considerable clinical importance, including their rheumatological manifestations, such is the case of Zika and dengue viruses.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The title of the article makes one think that it refers only to arthritogenic alphaviruses, but that does not occur in Table 1, where there is a broad spectrum of viruses that cause musculoskeletal manifestations, which makes one think that the authors are dealing in general with viruses of rheumatological importance. However, in this case, they should have mentioned, for example, Zika virus, which not only provokes arthralgia and other rheumatological manifestations, but has recently been detected directly in synovial fluid, where it can even remain for several weeks.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Speaking specifically of Chikungunya virus, one of the most important arthritogenic alphaviruses in terms of its acute and chronic morbidity and its persistence for long periods of time, in Colombia, between 2014 and 2015, there were more than 3 million new cases, and a proportion of nearly 50% of those patients developed chronic post-Chikungunya inflammatory rheumatism (pCHIK-CIR). This has been documented in a number of cohorts in the departments of Sucre,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Tolima<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and Risaralda,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> since the beginning of 2016, following along the lines of estimates<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and meta-analyses of observational studies conducted in other countries.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Thus it is surprising that, when discussing pCHIK-CIR, the authors refer only to studies dealing with Reunion Island in France, but there is absolutely no mention of Latin America.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to call attention to the relatively high frequency observed in certain reports, with ranges from 14.4% to 87.2%, as well as a mean persistence of 20.12 months in 47.57% of the patients (95% confidence interval: 45.08–50.13), and a duration of even more than 5 years.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,9</span></a> Thus, pCHIK-CIR has been established as a challenge for Latin American rheumatology.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, it is also surprising that there is such a limited reference to Mayaro virus, especially since, after Chikungunya, this arthritogenic alphavirus could be important not only because of its acute morbidity, but also chronic as well, in many Latin American countries. New outbreaks have recently been reported in Venezuela and in Haiti, among others. Thus, this virus should also be considered in the differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Morales AJ, Sánchez-Duque JA, Anaya J-M. Respuesta a: Alfavirus Tropicales Artritogénicos. Reumatol Clin. 2018;14:245–246.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alfavirus tropicales artritogénicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.-R. Mejía" 1 => "R. López-Vélez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2017" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacto de las arbovirosis artritogénicas emergentes en Colombia y América Latina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 37 | 31 | 68 |
| 2024 September | 36 | 16 | 52 |
| 2024 August | 49 | 35 | 84 |
| 2024 July | 29 | 23 | 52 |
| 2024 June | 37 | 23 | 60 |
| 2024 May | 63 | 26 | 89 |
| 2024 April | 48 | 17 | 65 |
| 2024 March | 37 | 30 | 67 |
| 2024 February | 29 | 22 | 51 |
| 2024 January | 22 | 21 | 43 |
| 2023 December | 19 | 22 | 41 |
| 2023 November | 31 | 23 | 54 |
| 2023 October | 26 | 28 | 54 |
| 2023 September | 57 | 31 | 88 |
| 2023 August | 23 | 11 | 34 |
| 2023 July | 21 | 23 | 44 |
| 2023 June | 28 | 25 | 53 |
| 2023 May | 32 | 22 | 54 |
| 2023 April | 14 | 8 | 22 |
| 2023 March | 49 | 31 | 80 |
| 2023 February | 32 | 29 | 61 |
| 2023 January | 29 | 14 | 43 |
| 2022 December | 58 | 28 | 86 |
| 2022 November | 41 | 25 | 66 |
| 2022 October | 51 | 33 | 84 |
| 2022 September | 44 | 29 | 73 |
| 2022 August | 35 | 43 | 78 |
| 2022 July | 27 | 34 | 61 |
| 2022 June | 31 | 32 | 63 |
| 2022 May | 42 | 37 | 79 |
| 2022 April | 57 | 64 | 121 |
| 2022 March | 41 | 46 | 87 |
| 2022 February | 41 | 26 | 67 |
| 2022 January | 43 | 47 | 90 |
| 2021 December | 38 | 43 | 81 |
| 2021 November | 47 | 50 | 97 |
| 2021 October | 51 | 62 | 113 |
| 2021 September | 30 | 38 | 68 |
| 2021 August | 32 | 36 | 68 |
| 2021 July | 19 | 20 | 39 |
| 2021 June | 21 | 17 | 38 |
| 2021 May | 35 | 51 | 86 |
| 2021 April | 51 | 64 | 115 |
| 2021 March | 41 | 28 | 69 |
| 2021 February | 29 | 25 | 54 |
| 2021 January | 18 | 13 | 31 |
| 2020 December | 29 | 29 | 58 |
| 2020 November | 34 | 12 | 46 |
| 2020 October | 12 | 11 | 23 |
| 2020 September | 70 | 24 | 94 |
| 2020 August | 74 | 14 | 88 |
| 2020 July | 38 | 19 | 57 |
| 2020 June | 28 | 20 | 48 |
| 2020 May | 18 | 11 | 29 |
| 2020 April | 16 | 14 | 30 |
| 2020 March | 23 | 2 | 25 |
| 2019 March | 1 | 0 | 1 |
| 2018 November | 0 | 1 | 1 |
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