Chikungunya viral arthritis mimicking seronegative rheumatoid arthritis


viral infection
seronegative rheumatoid arthritis

How to Cite

Boyadzhieva, V., Stoilov, N., Kurteva, E., & Stoilov, R. (2019). Chikungunya viral arthritis mimicking seronegative rheumatoid arthritis. Rheumatology (Bulgaria), 27(4), 49-54.


Chikungunya virus (CHIKV) is an arthritogenic arbovirus infection transmitted through the mosquitoes Aedes aegypti and Aedes albopictus. The clinical picture is diverse - from mildly flowing, almost asymptomatic forms to characteristic episodes of fever, polymyalgia, polyarthralgia, and arthritis. Globalization of the world is increasing the chances of infection spreading outside known endemic areas. This necessitates a broad differential diagnosis, especially in cases that mimic inflammatory joint diseases such as rheumatoid arthritis. The presented clinical case is of a patient who has returned from a trip to the Maldives and is the first in the Republic of Bulgaria as far as we know, and is established after a detailed literature reference has been made. Rheumatologists, even in non-CHIKV-endemic regions, should consider CHIKV in their evaluation of symmetric polyarthritis lasting above six weeks, especially in case of anamnesis for a trip to the endemic regions to CHIKV that are likely to expand in the near future. However, demonstrating positive antibodies to the Chikungunya virus is the rheumatologist‘s primary help in distinguishing the two diseases.


  1. Ross R. The Newala epidemic. J Hyg (Lond) 1956;54: 177-91.
  2. Hammon W.M., Sather G.E. Virological findings in the 1960 hemorrhagic fever epidemic (dengue) in Thailand. The Am J Trop Med Hygiene, 1964,13, (4), 629-641.
  3. Aikat B.K., Konar N.R., Banerjee G. Hemorrhagicfeverin Calcutta area. The Ind J Med Res, 1964,52(6),660-675.
  4. Thaikruea L., Charearnsook O., Reanphumkarnkit S., et al. Chikungunya in Thailand: a re-emerging disease? Southeast Asian J Trop Med Pub Health, 1997,28(2), 359-364.
  5. Kariuki Njenga M, Nderitu L, Ledermann JP et al. Tracking epidemic Chikungunya virus into the Indian Ocean from East Africa. J Gen Virol 2008;89:2754-60.
  6. Staples JE, Breiman RF, Powers AM. Chikungunya fever: anepidemiological review of a re-emerging infectious disease. ClinInfect Dis 2009;49:942-8.
  7. Miner J, Yeang H, Fox J et al. Chikungunya viral arthritis in United states. Arthritis & Rheumatology. 2015; 67;5; 1214- 1220.
  8. Kuehn BM. Chikungunya virus transmission found in the UnitedStates: US health authorities brace for wider spread. JAMA 2014;312:776-7.
  9. Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S. A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog 2007;3:e201.
  10. Hansen K.E., Arnason J., Bridges A.J. Autoantibodiesand common viral illnesses. Seminars in Arthritis & Rheumatism, 1998,27(5)263-271.
  11. Meron M.K., Amital H., Shepshelovich D., et al. Infectious aspects and the etiopathogenesis of rheumatoid arthritis. Clin Rev All Immun, 2009,37.
  12. Wirach Maek-a-nantawat and Udomsak Silachamroon, Presence of Autoimmune Antibody in Chikungunya Infection. Case Reports in Medicine, 2009, Article ID 840183, 4 pages, 2009.
  13. Labadie K, Larcher T, Joubert C, et al. Chikungunya disease in nonhuman primates involves long-term viral persistence in macrophages. J Clin Invest 2010;120:894-906.
  14. B. Sudeep and D. Parashar, Chikungunya: an overview. J Bios, 2008,33(4), 443-449.
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.