Since the emergence from the chikungunya virus in Brazil in 2014, a lot more than 700,000 instances have already been reported through the entire nation, corresponding to one-third of all cases reported in the Americas

Since the emergence from the chikungunya virus in Brazil in 2014, a lot more than 700,000 instances have already been reported through the entire nation, corresponding to one-third of all cases reported in the Americas. about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner. Pafuramidine estimated that 43% of patients had chikungunya symptoms for more than 3 months, and the persistence of symptoms after 12 months was reported in 21% of these cases. The study suggested that the prevalence of chronification may be related to the strain of the virus and that this may be higher among the genotypes of the Indian Ocean and the Asian lineage (39%) 10 . In the seroprevalence study by Dias et alconducted in Bahia, the persistence of joint symptoms was reported in 68.1% of study participants in the neighborhood of George Amrico and 75% in Alto Cemitrio, higher than the prevalence reported in the literature Pafuramidine 9 . Brazil is a country of continental dimensions, with 8 million square kilometers and about 209 million inhabitants. When we were analyzing case reports from several states in the Southeast, Midwest, and Northern Brazil, we observed small incidence rates compared to some states in the Northeast, the epicenter of the epidemic; this finding increases the probability that millions of inhabitants in the country will be susceptible in the event of new epidemics because several regions of the united states have high prices of house infestation from the vector 4 , 5 . From a medical demonstration perspective, there can be an preliminary design of acute febrile disease, but musculoskeletal manifestations are in charge of the greater rate of recurrence from the symptoms of the condition, happening in the acute persisting and stage following the regression of fever for weeks to even years. The distress and discomfort connected with joint manifestations within their different stages causes significant physical incapacity, thereby affecting the grade of life from the individuals affected with the condition. Suffering linked to the infection can be caused by discomfort and mental, feeling, and sleep problems in a substantial proportion of individuals 11 , 12 . Discomfort linked to CHIKV, beyond intense, can be unresponsive to analgesics. Pafuramidine Inside a scholarly research by Andrade et alinvolving 106 chikungunya instances, pain Pafuramidine intensity assessed by visual analogue scale (0-10) averaged 5.8. The authors reported that many of the patients pain symptoms did not respond to prescribed analgesics, with only 26% experiencing pain relief greater than 70%; it was also reported that 18.9% of the cases were characterized by neuropathic pain 13 . Despite the importance of the topic, only three guidelines worldwide systematize the treatment of musculoskeletal disease: the first was published in 2015 by a French group 14 ; the second one was published in Brazil in 2016 by a multidisciplinary team 15 , and was incorporated according to the guidelines for clinical management of the Brazilian Ministry of Health (BMH) of 2017 16 . In the same year, a consensus was published by the Brazilian Society of Rheumatology (BSR) 17 . METHODS After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the BSR and BMH prepared an update with Pafuramidine the FANCG main objective of developing flowcharts for the therapeutic approach of the musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare spread and apply this guideline.