Comparative evaluation of four therapeutic regimes in chikungunya arthritis: a prospective randomized parallel-group study

• Published in: Indian journal of rheumatology Vol. 4; no. 3; pp. 94 - 101
• Main Authors: Padmakumar, B, Jayan, Jacob B, Menon, Rejeesh MR, Krishnankutty, Binny, Payippallil, Rajan, Nisha, RS
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2009
• Subjects: Arthritis; chikungunya; hydroxychloroquine; Internal Medicine; management; Rheumatology; steroid; treatment; treatment; Arthritis; hydroxychloroquine; management; chikungunya; steroid
• ISSN: 0973-3698; 0973-3701
• DOI: 10.1016/S0973-3698(10)60189-6

Abstract Objective To evolve a treatment protocol for patients presenting in acute stage of chikungunya by identifying the best regimen from four treatment regimes. Materials and methods One hundred and twenty patients diagnosed to have chikungunya arthritis clinically were randomized to one of four groups receiving combinations of aceclofenac (200 mg/day), hydroxychloroquine (400 mg/day) and prednisolone (10 mg/day). Group A received aceclofenac alone; Group B received aceclofenac plus hydroxychloroquine; Group C received aceclofenac and prednisolone and Group D, all three agents. Study medications were given for 6 weeks with weekly follow-ups followed by a 6 weeks drug-free follow-up with visits at week 8 and week 12. Efficacy variables including visual analog scale (VAS) for pain, 20-point modified Barthel index for activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed and recorded during start of therapy and at all follow-up visits. Results Significant ( P < 0.001) reduction in VAS scores and improvement in ADL and IADL scores were observed in groups C and D compared to groups A and B. Between groups A and B there was no significant difference; similarly, between groups C and D also there was no significant difference. Conclusion Addition of prednisolone, and not hydroxychloroquine, to aceclofenac reduced pain and improved the quality of life in patients with acute chikungunya arthritis, compared to aceclofenac given alone in the management of early chikungunya fever. We propose a combination of non-steroidal anti-inflammatory drugs with corticosteroid as the best regimen in treating acute chikungunya cases with arthralgia.