Methotrexate in Early Chikungunya Arthritis: A 6 Month Randomized Controlled Open-label Trial

Author(s): M.B. Adarsh, Shefali K. Sharma*, Preksha Dwivedi, Mini P. Singh, Varun Dhir, Sanjay Jain

Journal Name: Current Rheumatology Reviews

Volume 16 , Issue 4 , 2020

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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.

Keywords: Methotrexate, NSAID, post-viral arthritis, steroid, chikungunya.

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Article Details

VOLUME: 16
ISSUE: 4
Year: 2020
Published on: 24 December, 2020
Page: [319 - 323]
Pages: 5
DOI: 10.2174/1573397115666190925154140
Price: $65

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