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Vol. 14. Issue 4.
Pages 245-246 (July - August 2018)
Vol. 14. Issue 4.
Pages 245-246 (July - August 2018)
Letter to the Editor
DOI: 10.1016/j.reumae.2017.07.004
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Response to: Tropical Arthritogenic Alphaviruses
Respuesta a: Alfavirus tropicales artritogénicos
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Alfonso J. Rodríguez-Moralesa,
Corresponding author
arodriguezm@utp.edu.co

Corresponding author.
, Jorge A. Sánchez-Duquea, Juan-Manuel Anayab
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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To the Editor,

We read the complete review recently reported by Mejía and López-Vélez on tropical arthritogenic alphaviruses with interest.1 However, based on our experience in Colombia, a country that is significantly affected by arboviruses, such as Chikungunya virus and Zika virus infections, there are certain aspects of the review that should have been mentioned.2

Latin America is seeing the emergence of new tropical viral agents, transmitted by arthropod vectors (arboviruses). They have been classified into 4 groups, A, B, C and D, the first 2 being of greater clinical importance.2 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.2 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.3

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,4 Tolima5 and Risaralda,6 since the beginning of 2016, following along the lines of estimates7 and meta-analyses of observational studies conducted in other countries.8 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.

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.7,9 Thus, pCHIK-CIR has been established as a challenge for Latin American rheumatology.

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.10

References
[1]
C.-R. Mejía, R. López-Vélez.
Alfavirus tropicales artritogénicos.
Reumatol Clin, (2017),
[2]
A.J. Rodríguez-Morales, J.M. Anaya.
Impacto de las arbovirosis artritogénicas emergentes en Colombia y América Latina.
Rev Colomb Reumatol, 23 (2016), pp. 145-147
[3]
L. Roimicher, O.C. Ferreira Jr., M.B. Arruda, A. Tanuri.
Zika virus in the joint of a patient with rheumatoid arthritis.
J Rheumatol, 44 (2017), pp. 535
[4]
A.J. Rodriguez-Morales, W. Villamil-Gomez, M. Merlano-Espinosa, L. Simone-Kleber.
Post-Chikungunya chronic arthralgia: a first retrospective follow-up study of 39 cases in Colombia.
Clin Rheumatol, 35 (2016), pp. 831-832
[5]
A.J. Rodríguez-Morales, C.E. Calvache-Benavides, J. Giraldo-Gómez, N. Hurtado-Hurtado, M.C. Yepes-Echeverri, C.J. García-Loaiza, et al.
Post-Chikungunya chronic arthralgia: results from a retrospective follow-up study of 131 cases in Tolima, Colombia.
Travel Med Infect Dis, 14 (2016), pp. 58-59
[6]
A.J. Rodriguez-Morales, A.F. Gil-Restrepo, V. Ramírez-Jaramillo, C.P. Montoya-Arias, W.F. Acevedo-Mendoza, J.E. Bedoya-Arias, et al.
Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. Version 2.
[7]
A. Rodriguez-Morales, J. Cardona-Ospina, W. Villamil-Gómez, A. Paniz-Mondolfi.
How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?.
Rheumatol Int, 35 (2015), pp. 2091-22094
[8]
A.J. Rodríguez-Morales, J.A. Cardona-Ospina, S. Fernanda Urbano-Garzón, J. Sebastian Hurtado-Zapata.
Prevalence of post-Chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis.
Arthritis Care Res (Hoboken), 68 (2016), pp. 1849-1858
[9]
J.A. Sanchez-Duque, J.P. Orozco-Hernandez, A.J. Rodriguez-Morales.
Rheumatic manifestations in patients with Chikungunya infection: comment on the article by Arroyo-Ávila and Vilá.
PR Health Sci J, 34 (2015), pp. 231-232
[10]
A.E. Paniz-Mondolfi, A.J. Rodriguez-Morales, G. Blohm, M. Marquez, W.E. Villamil-Gomez.
ChikDenMaZika Syndrome: the challenge of diagnosing arboviral infections in the midst of concurrent epidemics.
Ann Clin Microbiol Antimicrob, 15 (2016), pp. 42

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.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
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