Polyarthralgia in a young woman

A 22 year old Indian woman presented to the orthopaedic clinic with excruciating pain and swelling in multiple joints (knee, ankle, wrist, and elbow) for the past two weeks. She also had on and off high grade fevers for the past month, associated with a rash all over her body. There were no ophthalmic or urinary symptoms. Investigations on presentation to the clinic showed anti-chikungunya immunoglobulin M and G antibodies. She had been managed with simple analgesia. At the current presentation, on examination, her joints were mildly swollen and tender (fig 1⇓). Plain radiographs of the hand, knee, and ankle did not show any juxta-articular osteopenia or bone erosion. Fig 1 Asymmetrical swelling of knees (right more than left) The results of a full blood count showed a haemoglobin of 120 g/L (reference range 135-180 g/L), total leucocyte count of 8700 cells/µL (3500 to 10 500 cells/µL). Her erythrocyte sedimentation rate (15 mm/h) and C reactive protein (0.5 mg/L) were found to be within normal limits. Rheumatoid arthritis factor, antibodies against the cyclic citrullinated protein, antinuclear antibodies, and human leucocyte antigen B27 were also negative.