Title:Methotrexate in Early Chikungunya Arthritis: A 6 Month Randomized Controlled Open-label Trial
VOLUME: 16 ISSUE: 4
Author(s):M.B. Adarsh, Shefali K. Sharma*, Preksha Dwivedi, Mini P. Singh, Varun Dhir and Sanjay Jain
Affiliation:Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
Keywords:Methotrexate, NSAID, post-viral arthritis, steroid, chikungunya.
Abstract:
Objective: Evidence for treating chikungunya arthritis early in the course of illness is
scarce. This study assesses the efficacy of Methotrexate in early Chikungunya arthritis.
Methods: It is a randomized controlled open-label assessor-blinded trial with a crossover design.
Sixty patients with persistent post chikungunya arthritis with at least 3 or more tender or swollen
joints (28 joint count) were recruited. MTX arm was given oral Methotrexate and NSAID arm was
given NSAIDs (Naproxen 1 gm/day or Etoricoxib 120 mg/day). Patients were followed at 1, 2, 4
and 6 months. After 2 months patients in NSAID arm who have not achieved remission were given
MTX. The primary endpoint was remission (no tender or swollen joints by 28 joint count) at 6
months. Secondary endpoints were change in CDAI, Indian HAQ, total steroid use, total NSAID
use, and serious adverse effects. Intention to treat analysis was used.
Results: TJC, SJC, CDAI and HAQ were matched between two at baseline. Remission was
achieved by 28 patients (93%, CI- 78%-98%) in the NSAID arm and 26 patients (86%, CI-70%-
94%) in MTX arm (p=0.18). There was no significant difference in steroid need, change in HAQ,
CDAI, TJC or SJC. Those who have not achieved remission had higher disease activity at baseline.
Conclusion: A protocol-based approach with steroid and NSAIDs helped to achieve remission in
most patients with early subacute phase of post-Chikungunya arthritis and the effect was comparable
to that of early initiation of methotrexate.
