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Journal of Cellular Immunology

ISSN: 2689-2812

Original Research Open Access
Volume 6 | Issue 6 | DOI: https://doi.org/10.33696/immunology.6.211

Development of a Chikungunya Arthritis Disease Activity Score (CHIK-DAS) Based on a Prospective Cohort Study

Aileen Yu-hen Chang1,*, Samuel Joseph Simmens2, Hugh Watson3,4, Richard L. Amdur5, André Siqueira6, Abigale Marie Proctor7, Sarah Renee Tritsch7, Carlos Andres Herrera Gomez1, Liliana Encinales8, Alfonso Sucerquia Hernández1, Jose Forero-Mejía1, Alejandro Jaller1, Juan Jose Jaller9, J. Kennedy Amaral10, Ilana Heckler11, Gary Leonard Simon1, Larry Moreland12, Andres Cadena Bonfanti13, Gary Steven Firestein14
  • 1Department of Medicine, George Washington University, Washington, DC, USA
  • 2Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
  • 3Medical Development and Translational Science Department, Evotec ID, Lyon, France
  • 4Department of Hepatology and Gastroenterology, Aarhus University, Aarhus, Denmark
  • 5Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
  • 6Instituto Nacional de Infectologia Evandro Chagas – Fiocruz Lab. Doenças Febris Agudas, Manguinhos, Rio de Janeiro, Brazil
  • 7Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
  • 8Department of Medicine, Allied Research Society, Barranquilla, Atlántico, Colombia
  • 9CIMEDICAL, Barranquilla, Atlántico, Colombia
  • 10Department of Health Sciences, Federal University of Cariri, Barbalha, Ceará, Brazil
  • 11Department of Scientific Affairs, EUROIMMUN US, Mountain Lakes, New Jersey, USA
  • 12Department of Medicine, University of Colorado, Aurora, Colorado, USA
  • 13Centro de Investigación, Clínica de la Costa SAS, Barranquilla, Atlántico, Colombia
  • 14Department of Medicine, UC San Diego School of Medicine, San Diego, CA, USA
+ Affiliations - Affiliations

Corresponding Author

Aileen Y. Chang, Chang@email.gwu.edu

Received Date: October 02, 2024

Accepted Date: November 07, 2024

Citation:

Chang AY, Simmens S, Watson H, Amdur RL, Siqueira A, Proctor A, et al. Development of a Chikungunya Arthritis Disease Activity Score (CHIK-DAS) Based on a Prospective Cohort Study. J Cell Immunol. 2024;6(6):236-246.


Copyright: © 2024 Chang AY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: Chikungunya virus is spread by mosquitos and causes a debilitating chronic arthritis that has no standard treatment to date and no specific measures of disease activity. The objective of this expert group was to develop a measure of chikungunya arthritis that would be useful for clinical trials and patient care.

Methods: A group of rheumatologists and biostatisticians experienced in the clinical and pathological mechanisms of chikungunya evaluated component measures for inclusion in a chikungunya arthritis disease activity score (CHIK-DAS). Utilizing data from a Colombian cohort of 158 chikungunya arthritis patients, linear regression identified components that were independently associated with patient reported outcomes assessing disability, pain, physical and mental quality of life and mobility. A preliminary instrument was developed using multiple imputation and regression backward selection. Cutoffs for grading disease severity were determined.

Results: Stiffness, ankle tenderness, and a 30 tender joint count that included the 28 joints traditionally included in the Disease Activity Score-28 were selected in a regression model predicting a composite of five patient reported outcomes. A CHIK-DAS scoring formula was developed through a weighted combination of these selected variables. In comparison to the DAS-28, the CHIK-DAS had improved predictive value for a composite outcome of disability, pain, physical and mental quality of life and mobility. Disease activity cutoffs were defined for remission (<40), mild (40-49.99), moderate (50-59.99) and severe (60+) disease.

Conclusion: The CHIK-DAS is a chikungunya specific measure of disease activity that includes the DAS-28 with the addition of ankle tenderness and a stiffness item that are prominent components of chikungunya arthritis. CHIK-DAS may be used as a specific measure of disease activity in chikungunya arthritis in clinical trials and patient care. This metric needs further validation in additional cohorts.

Keywords

Chikungunya, Arthritis, Disease severity score, Quality of life, Disability, Pain, Clinical trials

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