In the sub-acute phase of Chikungunya virus disease, management is phase-guided and centres on alleviating pain and stopping the progression of inflammation. When the first-line anti-inflammatory step does not produce adequate pain relief within the expected window, a structured next-line protocol is indicated.
The patient is in the sub-acute phase of Chikungunya virus disease. The main objective at this stage is to alleviate pain and halt further inflammatory progression — goals that drive the choice and sequencing of treatment.
The preceding step used NSAIDs in full dose (unless contraindicated) for persistent symptoms and mild joint pain. Pain relief was reassessed within the first week, with the expectation of an adequate response by day 10. When reassessment at day 10 shows an inadequate response — joint pain remains insufficiently controlled — escalation to this protocol is indicated.
The clinical management of Chikungunya is based on the phase of the disease:
The main objective of management during this phase is to alleviate pain and stop the progression of inflammation.
Prednisone is given at a dose of 10 mg/d for 5 days with a progressive reduction over 10 days.
In severe presentations, prednisone is given in a dose of 0.5 mg/kg/day until an adequate response (adequate response is defined as the ability to walk without assistance and satisfactory pain control). Thereafter, the dose should continue till the full resolution of joint pain. After the complete resolution, the dose is continued for another 3-5 days, followed by gradual weaning by decreasing the dose by 5 mg/day every seven days.
Use of Corticosteroids should not be continued for more than 4 weeks.
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