Evaluation of the Efficacy of Intramuscular Immunoglobulin in Treating Post-Chikungunya Arthralgia
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Abstract
Background. Chikungunya virus (CHIKV) infection may be followed by persistent musculoskeletal symptoms, particularly chronic arthralgia and arthritis, causing pain, impairing mobility and function, and reducing quality of life. Conventional management is primarily symptomaticnd may include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, selected disease-modifying antirheumatic drugs (DMARDs), and rehabilitation, which often provide incomplete relief and are associated with long-term adverse effects. The evidence supporting specific therapies for persistent chikungunya-related rheumatic disease remains limited. Intramuscular immunoglobulin (IMIG), because of its immunomodulatory properties, may represent a potential therapeutic option.
Objectives. To evaluate the association of intramuscular immunoglobulin therapy with changes in pain, joint arthralgia severity, and joint mobility in patients with post-chikungunya arthralgia, and to document treatment-related adverse effects.
Methodology. This prospective observational study was conducted in a tertiary care hospital over 18 months. Sixty adults with post-chikungunya arthralgia of at least one-month duration were included. IMIG was administered as part of clinical management, and outcomes were prospectively observed before and after treatment. No additional investigational drug was administered. Pain intensity was assessed using the Visual Analogue Scale (VAS), arthralgia severity using the Patient-Reported Arthralgia Inventory (PRAI), and joint mobility by clinical range-of-motion assessment at baseline, one week, one month, and six months. Descriptive statistics, paired comparisons, repeated-measures ANOVA, and multivariable regression were used.
Results. Mean VAS decreased from 7.6 ± 1.1 at baseline to 4.9 ± 1.2 at one week, 3.1 ± 1.0 at one month, and 2.5 ± 0.8 at six months (p < 0.001). Mean PRAI score decreased from 6.2 ± 1.0 at baseline to 3.8 ± 1.1 at one week, 2.4 ± 0.9 at one month, and 1.9 ± 0.7 at six months (p < 0.001). At baseline, 70.0% of participants had moderate-to-severe restrictions of joint movement; at six months, 80.0% had normal or near-normal mobility. Overall functional improvement was reported by 85.0% of participants. Mild injection-site pain occurred in six patients (10.0%) and transient low-grade fever in four (6.7%); no serious adverse events or allergic reactions were observed. In multivariable analysis, a higher baseline VAS was associated with greater pain reduction, whereas increasing age and longer duration of arthralgia were associated with smaller reductions.
Conclusion. IMIG administration was associated with improvements in pain, arthralgia severity, and joint mobility in this prospective observational cohort. Controlled randomized studies are required to establish efficacy, comparative effectiveness, and safety.
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