Immunopathogenic mechanisms in chronic chikungunya arthritis
Keywords:
Chikungunya Fever; Arthritis; Inflammation; Interleukin-6; Interleukin-1; AntiviralsAbstract
This narrative review aims to analyze the immunopathogenic evidence explaining chronic chikungunya arthritis (CCA), integrating findings on the initial cytokine storm, the transition to chronicity, and the mechanisms of viral persistence versus autoimmunity. It concludes that CCA is primarily driven by CHIKV persistence in synovial macrophages, which maintains a chronic inflammatory state dominated by IL-6 and IL-1β, with a serological profile (anti-CCP negative) distinct from that of rheumatoid arthritis. The evidence supports a model in which persistent viral inflammation recruits local immunopathological mechanisms. These findings justify rethinking therapeutic strategies toward approaches that combine antiviral control with specific cytokine modulation, such as IL-6 blockade.
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