Management of chronic chikungunya arthritis (>3 months)
| Treatment | Comments |
|---|---|
| NSAIDs, paracetamol and weak opioids | Ibuprofen 400 mg three times daily, diclofenac 50 mg twice daily, naproxen 250 mg twice daily, aceclofenac 200 mg daily |
| Oral prednisolone | 5–10 mg/day; in confirmed synovitis and tenosynovitis, to taper in 1–2 weeks, maximum for 4 weeks (French guidelines) and 6–8 weeks (Brazilian guidelines) |
| Hydroxychloroquine | 5 mg/kg/day, maximum 400 mg daily |
| Methotrexate | 10–25 mg/week with folic acid 1 mg/day |
| Sulfasalazine | 1–2 g/day |
| Biologic therapy | TNFi (in resistant cases as per local guidelines) |
| Tricyclic antidepressants and anticonvulsants | Oral amitriptyline 25–50 mg/day, oral pregabalin 50–150 mg two to four times a day and oral gabapentin 300 mg two to three times daily |
NSAIDs = non-steroidal anti-inflammatory drugs; TNFi = tumor necrosis factor inhibitor.