Chronic musculoskeletal pain among Ebola survivors in Guinea: a cross-sectional study reveals key risk factors and the need for specialized care

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OBJECTIVES: The tremendous size of the 2013-16 West African outbreak of Ebola virus disease (EVD) resulted in a sizeable population of survivors, many reporting short-term sequelae such as arthralgia and myalgia. We aimed to examine the occurrence of chronic musculoskeletal (MS) pain among survivors. METHODS: We performed a cross-sectional study following systematic rheumatological screening of patients included in the PostEboGui cohort (Conakry district). We used regression models to establish the magnitude of EVD as a risk factor for developing chronic MS pain by comparison with a control cohort of seronegative individuals living in the same area and to establish risk factors for developing MS pain among survivors. RESULTS: The study included 313 patients (55.6% female), with a median age of 28.2 years (interquartile range [IQR] 21-37), and a median time from Ebola Treatment Centre (ETC) discharge to rheumatological visit of 26.2 months (IQR 23-30). Chronic MS pain was reported in 216 (69%) patients. Enthesis and painful peripheral joints were largely involved 196 (91%) with symmetrical distribution. Previous Ebola infection was a major risk factor for chronic MS pain (adjusted odds ratio [aOR], 6.66 [95% CI, 4.52-9.92]). Among survivors, increasing age (OR 1.14, 95% CI 1.08-1.22) and female gender (OR 3.58, 95% CI 1.22-11.80) were both associated with current MS pain, while myalgia experienced during the acute phase of EVD appeared protective (OR 0.14, 95% CI 0.04-0.42). CONCLUSION: Our study provides the most accurate long-term description of MS disorders among Ebola survivors. Joint and muscle pain sequelae are frequent and require specialized care.