Fibrosis — A Common Pathway to Organ Injury and Failure

n engl j med 373;1 nejm.org july 2, 2015 95 cause there is a need to define the disease burden and costs associated with chikungunya virus infection, and there are important therapeutic implications underscored by Simon et al., because disease-modifying drugs such as methotrexate should be prescribed only to patients who truly have chronic inflammatory rheumatism. Little is known regarding the underlying mechanisms of the symptoms of chronic chikungunya fever, including the viral and host factors responsible for rapid recovery versus the development of chronic musculoskeletal symptoms, arthralgia, arthritis, or destructive arthritis. This constitutes a major scientific challenge that will require both experimental systems and detailed analyses involving appropriate patient cohorts. Cabie and colleagues share the results of their first clinical analysis involving patients infected with chikungunya virus in Martinique. They confirm that the high incidence of chronic symptoms associated with Indian Ocean lineage virus strains circulating in Asia is also observed with the Asian strains recently introduced from Asia into the Americas. It is also important to stress that, given the variety of chronic symptoms associated with chikungunya virus infection, the absence of biomarkers to monitor disease progression, and the very limited therapeutic options available, providing patients with access to a multidisciplinary outpatient clinic can be very helpful in disease management. Scott C. Weaver, Ph.D.