Current and future advances in practice: arboviral arthritides

Arboviral arthritides are a group of viral infections affecting the musculoskeletal system. Mosquitoes are vectors for some of the arboviral febrile diseases such as due to chikungunya, dengue and Zika viruses, which constitute a major proportion of arboviral arthritide syndromes in humans. They have gained epidemiological importance as the natural habitats of these mosquitoes are in the vicinity of human dwellings. Chikungunya virus infection frequently leads to post-infectious chronic musculoskeletal syndromes including erosive inflammatory arthritis, which resembles RA. Clinical features of the chronic phase result from the chronic persistence of the virus in certain tissues after the acute infection has resolved. In addition, the triggering of autoimmunity has also been implicated in musculoskeletal syndromes. Due to the diversity of clinical presentations and overlapping features with other viral illnesses and inflammatory arthritides, diagnosis and management are challenging. Poor prognostic factors for predicting evolution to chronic arthritides are not well delineated. There is no universal agreement regarding when to start immunomodulatory agents and the duration of such therapy. The lack of specific antiviral agents adds to the complexity of the situation. A live-attenuated vaccine has been recently approved by the US Food and Drug Administration for the prevention of chikungunya virus infection. This review discusses the musculoskeletal syndromes related to arboviral infections, with a major focus on chikungunya virus-related arthritis to provide practical guidance to clinicians involved in managing patients with chikungunya and its sequelae.