3 years ago

Treatment of chronic chikungunya arthritis with methotrexate: a systematic review

Ravi Sutaria, J. Kennedy Amaral, Robert T. Schoen
Objectives Chikungunya is a rapidly emerging, global viral infection that can cause chronic, debilitating arthritis that in some ways mimics rheumatoid arthritis. This study evaluated the available evidence of the efficacy and safety of methotrexate (MTX), a therapy widely used in rheumatoid arthritis, in the treatment of chronic chikungunya arthritis. Methods A systematic literature search was performed to identify all published trials that evaluated MTX as monotherapy or combination therapy in chronic chikungunya arthritis. PubMed, Scielo, Scopus and Cochrane Library databases were searched from inception to August 2017. We also searched Google Scholar, International Clinical Trials Registry Platform Search Portal and clinicaltrials . gov. Results Among 131 possibly relevant studies, six met our criteria for evaluation; four were retrospective studies, one was an uncontrolled prospective study, and one was an unblinded randomized clinical trial of combination MTX therapy. In this study, MTX in combination with hydroxychloroquine (HCQ) and sulfasalazine (HCQ) was superior to HCQ monotherapy as assessed by Disease Activity Score (DAS28ESR 3.39+/-0.87 versus 4.74+/-0.65, p <0.0001) and Health Assessment Questionnaire (HAQ 1.14+/- 0.31 versus 1.88+/- 0.47, p <0.0001). Conclusion The available studies are limited, but taken together demonstrate sufficient efficacy to justify interest in the treatment of chronic chikungunya arthritis with MTX. The trials lacked rigorous study designs and used different treatment strategies and outcome measures. This systematic review underscores the need for randomized prospective, placebo-controlled studies of MTX monotherapy in the treatment of chronic chikungunya arthritis. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23519

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