A significant proportion of patients with chikungunya fever develop rheumatoid arthritis (RA) following infection with the chikungunya virus (CHIKV), according to a recent meta-analysis (Trop Med Infect Dis 2025;10[2]:54).
“I have always been struck by the impact of chikungunya fever on people’s health, especially the high number of patients who continue to experience joint pain and inflammation for months or even years after infection,” said the lead author of the report, JosÉ Kennedy Amaral, MD, a doctor in the Postgraduate Program in Health Sciences and faculty of medicine at Federal University of Cariri, in CearÁ, Brazil. “As a rheumatologist, I often see cases where post-viral arthritis closely resembles rheumatoid arthritis, but there was a lack of comprehensive analysis on this connection.
“Our study helps fill that gap,” Dr. Amaral said.
The review included data from literature searches of multiple databases through Sept. 3, 2024. Ultimately, 16 studies of 2,879 patients were included. Among the people with chikungunya, approximately 13.7% later developed RA. Among studies the researchers deemed to be of higher quality—cohort studies classed as having low risk for bias—the percentage of people with CHIK infection who developed RA was 17.7%.
These findings "reinforce the need for long-term rheumatologic follow-up in these patients and raise important questions about whether chikungunya virus may act as a trigger for autoimmune diseases,” Dr. Amaral said.
However, he noted a high level of heterogeneity among the studies suggests that “factors such as differences in diagnostic criteria, study populations and follow-up durations may have influenced the results.”
What Kind of Arthritis?
Further complicating the issue, a question remains regarding whether CHIKV increases the risk of developing RA, or if some people with chronic chikungunya arthritis (CCA) present as RA mimics.
“This is the question that many doctors and researchers are trying to answer,” Dr. Amaral told Infectious Disease Special Edition. “Our study shows that in some cases, CCA can be indistinguishable from RA, with positive autoantibodies and even erosive joint damage. This suggests that the virus may indeed act as a trigger for RA in certain patients.
“However, we still cannot say with certainty whether chikungunya virus causes RA or simply triggers it in people who are already genetically predisposed,” he continued. “For me, this remains an open question that requires further investigation.”
Other unanswered questions remain, too, which may benefit from future research.
Dr. Amaral would like to see more investigation about whether CHIKV remains active in the joints and contributes to chronic inflammation, as well as studies looking at genetic and immunological factors that differentiate those who develop RA from those who fully recover. Finally, trials that look at treatment to see if conventional RA therapies, such as methotrexate and biologics, would be effective.
Overall, the of Dr. Amaral's analysis reinforce a connection between chikungunya and RA, and that long-term rheumatologic follow-up is needed in patients who have survived CHIKV infection, particularly those in regions where the virus is endemic.
“What this study makes clear to me is that chronic chikungunya arthritis should not be underestimated,” Dr. Amaral said. “Many patients suffer from pain and limitations for years after infection, and we now have more evidence that some may, in fact, develop RA. The next step is to dive even deeper into this research to provide more accurate diagnoses and more effective treatments for these individuals.”
Dr. Amaral reported no relevant financial disclosures.
This article is from the April 2025 print issue.