RANDOMIZED CLINICAL TRIAL IN CHIKUNGUNYA ARTHRITIS CASES

CORRESPONDING AUTHOR
Dr. Mansoor Ahmed
Associate Professor,
Dept  of Community Medicine, MMCRI, Mysore.
E-mail: docmansoor2000@yahoo.com,
Ph: 0091 9945939275

ABSTRACT: Chikungunya virus is no stranger to the Indian sub-continent. Since its first isolation in Calcutta[1] in 1963, there have been several reports of chikungunya virus infection in different parts of India[2], [3], [4]. The last outbreak of chikungunya virus infection occurred in India in 1971. Subsequently there has been no active or passive surveillance carried out in the country and therefore, it ‘seemed’ that the virus had ‘disappeared’ from the subcontinent[5] However, recent reports of large scale outbreaks of fever caused by chikungunya virus infection in several parts of Southern India have confirmed the re-emergence of this virus. It has been estimated that over 1,80,000 cases have occurred in India since December 2005 [6] Andhra Pradesh (AP) was the first state to report this disease in December 2005, and one of the worst affected (over 80,000 suspected cases) . Over 12% of patients who contract chikungunya virus infection develop chronic joint symptoms [7]. OBJECTIVE:  To test the efficacy of chloroquine in reducing the pain of chikungunya induced arthritis as compared to paracetamol. METHODOLOGY: A Randomized Clinical Trial was carried out in a community attached to urban health centre of PESIMSR, Kuppam during August 2006. Among the 132 cases of arthritis, 86 persons were selected based on their availability and consent to participate. They were divided into two randomly assigned groups namely Category–1(Chloroquine group)  and Category–2  ( Paracetamol group). Chloroquine tablet -155 mg and Paracetamol tablet - 500 mg were administered as a single dose to the two groups respectively. The groups were followed up for 8 days and the results were analyzed. STATISTICAL ANALYSIS:  Analysis was carried out by using S.P.S.S. package.   Asymptoic test statistic and X2 MH (Chi square test ) were used to evaluate the effect of the drugs. RESULTS OF THE STUDY: The decrease of pain in chikungunya arthritis cases was significant in the mild and moderate pain categories with ‘p’ values of 0.0117 and 0.0129 respectively.
Asymptoic test statistic was 1.70 for chloroquine group and χ²MH was 2.76 (’P’ value  between 0.05 to 0.1).OR= 48.59.Incidence Risk Ratio for chloroquine was 1.52 with CI ; 1.14 – 1.90.The efficacy of chloroquine in reducing pain in arthritis was 51.83% ( effect size).The logistic equivalents of odds for chloroquine and paracetamol group were 0.41 and 0.02 respectively in logistic regression analysis. CONCLUSION: Choloroquine is more efficient in reducing the pain of chikungunya arthritis as compared to paracetamol in both sexes and in all age groups.
KEY WORDS:   Chikungunya, Arthritis, Clinical Trial, Chloroquine.