When joint pain lingers, you might assume it's arthritis. But if you've traveled internationally, it could be a mosquito-borne disease.
Some Americans traveling internationally are coming home with chikungunya, a viral disease transmitted by mosquitoes that has symptoms similar to rheumatoid arthritis. Doctors have been advised to look out for it.
As of January 2015, more than 1 million cases had been reported in the Caribbean islands, Latin American countries, and the United States, according to the World Health Organization (WHO).
Chikungunya has an explosive onset, says William Schaffner, MD, chairman and professor of preventive medicine at Vanderbilt University in Nashville. “Yesterday you were fine, and today you have a high fever and chills and you have severe joint pain," he says. Other chikungunya symptoms can include sensitivity to light, headaches, nausea, vomiting, muscle pain, and a rash that may or may not be itchy. Symptoms usually occur within three days to a week of the person being bitten by either of the two types of mosquitoes that carry the virus, according to the Centers for Disease Control and Prevention (CDC).
You can feel better but then have symptoms again because “the disease abates but can come back,” Dr. Schaffner says.
Lingering Joint Pain Resembles RA
Some people with chikungunya improve in a week, some after two or three, and some still aren’t better after eight months, says Jonathan Miner, MD, PhD, a third-year fellow in the department of rheumatology at Washington University in St. Louis.
RELATED: 6 Things People With Rheumatoid Arthritis Wish You Knew
Even when acute symptoms like fever and rash disappear, the joint pain can linger for many months or years and can mimic adult rheumatoid arthritis (RA), he says. As a result, some people see a rheumatologist to get treatment for their persistent pain, not connecting it with having had the virus. That’s why he and colleagues published a study in Arthritis & Rheumatology in January 2015 advising rheumatologists to consider chikungunya before treating patients for RA.
With chikungunya, joint pain and stiffness tend to be worse in the morning, Dr. Miner says. It’s the same with RA, according to the American College of Rheumatology. Chikungunya very commonly affects the ankles, wrists, and small joints of the hand. So does RA. As with RA, your knees and shoulders also can be affected, multiple joints may be painful, and the hurting can come with swelling and accumulation of fluid in your joints, according to Miner.
Report Your Travel, Disease History
To get the right diagnosis, Miner says, it's critical to tell your doctor if you had a high fever and chills and recently traveled to areas of the world where chikungunya outbreaks have been reported. That includes the Caribbean, South America, southern Europe, Southeast Asia, Africa, and islands in the Indian and Pacific oceans, according to the CDC. Miner's study describes a group of 10 American travelers who were nearly simultaneously infected while visiting Haiti in June 2014.
Doctors, too, need to be more aware of the possibility of chikungunya. When a patient has arthritic complaints and has had a fever, Schaffner says, the doctor must ask, “Where have you traveled?”
However, in July 2014, a Florida man contracted the virus without having traveled internationally, according to the CDC. His was the first reported case of chikungunya acquired in the United States.
“As the disease spreads, we’re going to find people who didn’t travel to a place that is known to have it,” predicts Aileen Marty, MD, a professor and director of the Health Travel Medicine Program and Vaccine Clinic at Florida International University.
Diagnosis, Treatment, and Prevention
To diagnose chikungunya, your doctor will order blood tests. The virus can be detected by a polymerase chain reaction (PCR) in the first week or by antibody testing if it has been more than a week since the initial infection, Miner says. (PCR allows detection of viral nucleic acids.) To check for RA, your doctor may order a test that looks for rheumatoid factor or certain antibodies in your blood, according to the University of Washington Medicine.
Treatment for chikungunya includes fluids and nonsteroidal anti-inflammatory drugs (NSAIDs) that can help reduce fever and pain. No vaccines or anti-viral medications have been developed to effectively treat the virus, according to Dr. Marty.
That makes prevention really important for chikungunya, Miner says. “If you travel to an area of the world where there has been an outbreak of chikungunya, you need to use mosquito repellent and keep the windows closed in your hotel room and use the air conditioning instead,” he says. “If you open windows, you let the mosquitoes in with the breeze.”
Other prevention tips from the WHO: Wear long sleeves and long pants when you're outdoors, especially at dawn and at dusk. And stay away from places where mosquitoes breed, like birdbaths or others containers filled with standing water.
Serious complications and death from chikungunya are rare, but people with other health issues, the elderly, and young children should be particularly careful about avoiding mosquito bites when in regions where the virus has been observed.
Source: Everydayhealth
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