Arthritis pain high in patients post Dengue and Chikungunya fever

NOIDA ROHIT SHARMA

It is a proven fact that an increasing number of patients after viral fever like Dengue and Chikungunya complain of persistent joint and muscular pain. On this occasion of World Arthritis Day, Fortis Hospital, Noida shares the causes and effects of these consequences.  The initiative is led by Dr. Atul Mishra, Additional Director, Dept of Orthopaedics & Joint Replacements, Fortis Hospital, Noida to create further awareness to understand these pains and its roughness.  Chikungunya is proven to have a severe form of joint pain and can subsequently, even result in arthritis. If neglected this pain sometimes carries on for months and can be crippling. Maintaining good health along with good nutritious intake helps fight the disease better. People testing deficient in micronutrients like Vitamin D, B12 and E often complain of persistent muscle and joint pains as compared with those who have sufficient amounts of these vital nutrients. Although severe arthritis is more common in chikungunya, it has been observed that a lot of dengue patients also suffer from joints and bone pain.  Dengue, also known as ‘breakbone fever’ because of the shattering pain it causes, is transmitted by a mosquito found in warm climates, and is not contagious. People often contract dengue fever without realizing it or recognising that they have contracted it. In some cases this can even lead to dengue haemorrhagic fever, a severe form of the illness which causes internal bleeding resulting in shock and even death. Dengue also has pathological consequences on tendons, muscles, joints and bones. Pains which are associated with dengue are acute reactive arthritis during dengue fever and chronic joint pain after dengue. These are generally treated with paracetamol and few simple exercises. But what is noteworthy is these Joint pains are intense in patients suffering from vitamin deficiencies.   Joint or arthritis pain is usually symmetric, involving large and small joints of the upper and lower limbs; it commonly arises in the wrists, elbows, fingers, knees and ankles.  However, knees are the most commonly involved and hip and shoulder are less affected.An increasing number of people who have recovered from dengue are complaining of persistent joint and muscular pains. Doctors say an unprecedented number of dengue patients in the city have reported emergence of viral polyarthralgia (pain in several joints) and myalgia (muscle pain), a condition that persists for days after recovery. Associated vitamin and mineral deficiency has made the pain serious and debilitating in many cases.
Experts blame rapid and uncontrolled urbanisation for facilitating spread of mosquito-borne diseases, viral reactive arthritis, myalgia and polyarthralgia that cause viral fever like dengue, chikungunya, etc. “Several patients complain of muscle and joint pains for as long as two to three weeks after the disease has subsided. This is especially seen in the elderly. In last 15 years of my practice in Pune, I have not seen so many cases,”said orthopaedic surgeon Ramesh Ranka. “In dengue, myalgia or muscle pain is prominent. A patient with chikungunya has a more severe form of joint pain and arthritis that sometimes goes on for months and can be crippling. Patients with compromised immune system such as diabetics or those taking drugs like immunosupressants, or suffering from chronic ailments of liver and kidneys, compromised respiratory function are prone to suffer from severe form of disease,” Ranka said
The orthopaedic surgeon said that Vitamins D and E boost recovery. “Therefore, maintaining good health and levels of nutrition will help fight the disease better. Those deficient in micronutrients like Vitamin D, B12 and E are often seen complaining of persisting muscle and joint pains when compared with those who have sufficient amounts of the vital nutrients,” he added. Orthopaedic surgeon Kiran Shete said, “Dengue does have pathological effects on tendons, muscles, joints and bones. Increased risk of myalgia and polyarthralgia are seen in dengue patients with associated co-morbid conditions, patients with vitamin and mineral deficiencies, those who are elderly and children who are malnourished.” Polyarthralgia in dengue fever is quite common. “Though severe arthritis is more common in chikungunya fever, we now-a-days we see a lot of dengue patients coming with joint and bone pains. In last three months, I have seen more patients complaining of joint and muscle pain even days after recovery from dengue. This trend is usually seen between June and September. This year the number of patients is more,” said Shete.
Two types of pain are associated with dengue — acute reactive arthritis during dengue fever and other is chronic joint pain after dengue. They are treated with paracetamol and simple exercises. Joint pains are intense and serious in those with vitamin deficiencies. “In the acute stage of viral fever, joint pain is usually symmetric, involving large and small joints of the upper and lower limbs. Joint pain occurs commonly in wrists, elbows, fingers, knees and ankles; nevertheless, the knee is the most commonly involved joint and the proximal joints, hip and shoulder are less affected,” he said.Dr. Atul Mishra, Additional Director, Dept of Orthopaedics & Joints Replacements, Fortis Hospital, Noida elaborated on this medical condition stating, “If a patient has been diagnosed with dengue and Chikungunya then joint pains, stiffness and swelling in joints should be attended to seriously and not be neglected. People should consult a specialist to ensure appropriate and adequate treatment like anti-inflammatory medicines, physical and manual therapy to prevent long standing arthritis. Most of the times these symptoms of joint pains can be reversed as the fever abates.  However, this year it was observed that in the cases of more than 90% of patients the symptoms have been persistent and recurrent.” Gagan Sehgal, Zonal Director, Fortis Hospital, Noida said, “The team of the doctors at Fortis Hospital Noida extend treatment which is holistic and cures not just the medical condition of the patient not just as it is presented to them but also a condition that could be consequential. This is what makes the patient more satisfied in having received the correct and timely treatment for their medical conditions.”