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Pan-American League of Associations for Rheumatology–Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America

Monge, Pablo, MD*; Vega, José Manuel, MD*; Sapag, Ana María, MD; Moreno, Ilsa, MD; Montúfar, Rubén, MD§; Khoury, Vianna, MD; Camilo, Pablo, MD; Rivera, Ruddy, MD#; Rueda, Juan C., MD**; Jaramillo-Arroyave, Daniel, MSc††; Londoño, John, PhD‡‡; del Carmen Ruiz, María, MD§§; Fernández, Félix, MD∥∥; Quintero, Maritza, PhD¶¶; Fuentes-Silva, Yurilis, MD##; Aguilar, José Luis, MSc***; Vallejo-Flores, Carlos, MD†††; Caballero-Uribe, Carlo V., PhD(c)‡‡‡; Sandoval, Hugo, M Ec§§§; Pineda, Carlos, MD, PhD§§§

JCR: Journal of Clinical Rheumatology: March 2019 - Volume 25 - Issue 2 - p 101–107
doi: 10.1097/RHU.0000000000000868
Practice and Health Policy

Background/Objective Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life—from many months to years—after the acute phase of the infection, with a significant impact on public and individual health.

The aim of this work was to establish Pan-American League of Associations for Rheumatology–Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA.

Methods Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation.

Results The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections.

Recommendations Pan-American League of Associations for Rheumatology–ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.

From the *Hospital México, Caja Costarricense de Seguro Social, Universidad de Costa Rica, San José, Costa Rica;

Hospital Universitario Japonés, Santa Cruz, Bolivia;

Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Panamá, Panamá;

§Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador;

Clínica Unión Médica, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana;

Clínica Corominas, Santiago, República Dominicana;

#Centro Médico Militar, Guatemala, Guatemala;

**Universidad de La Sabana, Chía, Cundinamarca;

††Universidad CES–Universidad de Antioquia, IPS Universitaria, Medellín; and

‡‡Universidad de La Sabana–Hospital Militar Central, Bogotá, Colombia;

§§Universidad de Carabobo, Sede Aragua, Maracay;

∥∥Clínica Razetti de Barquisimeto, Unidad de Reumatología, Barquisimeto;

¶¶Universidad de Los Andes, Unidad de Reumatología del Instituto Autónomo, Hospital Universitario de Los Andes, Mérida; and

##Unidad de Reumatología–Complejo Hospitalario Universitario Ruiz y Páez, Universidad de Oriente–Departamento de Medicina, Centro Clínico Universitario de Oriente, Bolívar, Venezuela;

***Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Perú;

†††Pontificia Universidad Católica del Ecuador, Quito, Ecuador;

‡‡‡Unidad de Reumatología, Hospital Universidad del Norte, Barranquilla, Colombia; and

§§§División de Enfermedades Musculoesqueléticas y Reumáticas, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México.

The authors declare no conflict of interest.

Correspondence: Carlos Pineda, MD, PhD, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México–Xochimilco 289, Col. Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico. E‐mail:

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