Newer rehabilitation therapies: strategies in chikungunya chronic arthralgia

Editor – Pathak et al looked over epidemiology, immunopathogenesis and management of chikungunya arthritis and reported several medication treatments in acute and chronic phase, however there is no discussion of physical rehabilitation.^1,2

Since chikungunya could be considered as a neglected tropical disease, potentially affecting over 1 billion people, additional supportive managements should also be investigated to establish more strategies to prevent arthralgia and increase functionality.^3–5 As in other rheumatic diseases, the recommended managements for chikungunya aim to prevent disability, unproductive work and secondary manifestations.^6–8 The chronic chikungunya arthralgia/arthritis symptoms suggests an immune mechanism to medication treatments, however the growing scientific evidences of physical rehabilitation improving functionality and quality of life should be more explored at the managements.⁶ The World Health Organization and several societies of rheumatology recommend rehabilitation interventions in all phases of chikungunya, and include exercises, stretching, manual therapy and aquatic physical therapy.^9,10 Moreover, two recent trials suggest novel approaches of rehabilitation therapies with transcranial direct current stimulation and pilates to reduce pain and improve functionality.^4,11 The long-term burden of persistent arthralgia negatively impacts the public health system, economically active people and quality of life.¹⁰

Therefore, the association between pharmacological and physical rehabilitation could enhance the chikungunya management efficiency, decreasing chronic pain symptoms and treatment abandonment. Scientific evidence of several healthcare fields should support the development of a more complete chikungunya guideline to properly adjust to the individual patient needs, causing significant changes to their quality of life and general functionality.