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Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: an electrophysiological and ultrasonographic study

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Abstract

This study aimed to investigate the carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compare the electrophysiological and ultrasonographic findings and evaluate related variables. Cut-off value of median nerve cross-sectional area (MCSA) was determined for the diagnosis of CTS. 70 RA patients, 39 PsA patients, a control group of 70 healty people were included in this study. Demographic characteristics, disease activity and functional status were recorded. Patients were referred for nerve conduction studies performed according to the American Academy of Neurology standards. Sonographic examination was carried on for MCSA evaluation. The mean age of patients was 51.87 ± 8.47, 50.61 ± 11.33, 49.75 ± 10.52 years and female ratio was 72.9%, 71.8%, 75.7% in RA, PsA and controls, respectively. Electrophysiologically, CTS frequency was found to be 13.2%, 15.4%, 3.5% in RA, PsA, control group, respectively, and a significant difference was found compared to the control group (p < 0.05). Ultrasonographically MCSA was measured as 8.52 ± 2.19 mm2, 8.97 ± 2.41 mm2, 7.09 ± 1.83 mm2 in RA, PsA, control group, respectively, a significant difference was observed compared to the control group (p < 0.05). As a result of the Receiver Operating Characteristics analysis, the thereshold value of MCSA for CTS was determined as 10.5 mm2.The frequency of CTS was found to be 30% in RA and 41% in PsA. The frequency of CTS with both ENMG and USG (MCSA) were higher in patients with RA and PsA as compared to the control group. Although it was not statistically significant, CTS frequency was higher in PsA than RA. To our knowledge this is the first study assessing CTS in patients with PsA, and adressing MCSA cut off value for CTS diagnosis in RA and PsA.

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References

  1. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB (2014) Carpal tunnel syndrome—Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 49:429–436

    Article  Google Scholar 

  2. Hammer HB, Hovden IA, Haavardsholm EA, Kvien TK (2006) Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology 45:584–588

    Article  CAS  Google Scholar 

  3. Karadag O, Kalyoncu U, Akdogan A, Karadag YS, Bilgen SA, Ozbakır S, Filippucci E, Kiraz S, Ertenli I, Grassi W, Calgüneri M (2012) Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity. Rheumatol Int 32:2313–2319

    Article  Google Scholar 

  4. Aktürk S, Büyükavcı R, Ersoy Y (2020) Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests. Acta Neurol Belg 120:43–47

    Article  Google Scholar 

  5. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

    Article  Google Scholar 

  6. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  Google Scholar 

  7. Wells G, Becker JC, Teng J, Dougados M, Schiff M, Smolen J, Aletaha D, van Riel PL (2009) Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 68:954–960

    Article  CAS  Google Scholar 

  8. Schoels M, Aletaha D, Funovits J, Kavanaugh A, Baker D, Smolen JS (2010) Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis 69:1441–1447

    Article  Google Scholar 

  9. Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdoğan C (2006) Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil 28:1281–1285

    Article  Google Scholar 

  10. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN (1993) A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 75:1585–1592

    Article  CAS  Google Scholar 

  11. Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A (2004) Issues in cross cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Care Res 51:14–19

    Article  Google Scholar 

  12. Oh SJ (2003) Nerve conduction techniques. In: Oh SJ (ed) Clinical electromyography: nerve conduction studies, 3rd edn. Lippincott Williams and Wilkins, Philadelphia, pp 37–53

    Google Scholar 

  13. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation (2002) Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 25:918–922

    Article  Google Scholar 

  14. Srikanteswara PK, Cheluvaiah JD, Agadi JB, Nagaraj K (2016) The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. J Clin Diagn Res 10:13–18

    Google Scholar 

  15. McDonagh C, Alexander M, Kane D (2015) The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology 54:9–19

    Article  CAS  Google Scholar 

  16. Lee KH, Lee CH, Lee BG, Park JS, Choi WS (2015) The incidence of carpal tunnel syndrome in patients with rheumatoid arthritis. Int J Rheum Dis 18:52–57

    Article  CAS  Google Scholar 

  17. Agarwal V, Singh R, Wiclaf CS, Tahlan A, Ahuja CK, Goel D, Pal L (2008) A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol 27:841–844

    Article  Google Scholar 

  18. Carmona L, González-Alvaro I, Balsa A, Angel Belmonte M, Tena X, Sanmartí R (2003) Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity. Ann Rheum Dis 62:897–900

    Article  CAS  Google Scholar 

  19. Veale D, Yanni G, Rogers S, Barnes L, Bresnihan B, Fitzgerald O (1993) Reduced synovial membrane macrophage numbers, ELAM-1 expression, and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis. Arthritis Rheum 36:893–900

    Article  CAS  Google Scholar 

  20. Fromm S, Cunningham CC, Dunne MR, Veale DJ, Fearon U, Wade SM (2019) Enhanced angiogenic function in response to fibroblasts from psoriatic arthritis synovium compared to rheumatoid arthritis. Arthritis Res Ther 21:1–11

    Article  Google Scholar 

  21. El Miedany YM, Aty SA, Ashour S (2004) Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology 43:887–895

    Article  Google Scholar 

  22. Yagci I, Akdeniz Leblebicier M, Mansiz Kaplan B, Ozturk Gokbakan D, Akyuz G (2006) Sonographic measurements can be misleading for diagnosing carpal tunnel syndrome in patients with rheumatoid arthritis. Acta Reumatol Port 41:40–44

    Google Scholar 

  23. Yoshii Y, Zhao C, Amadio PC (2020) Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics 10:596. https://doi.org/10.3390/diagnostics10080596

    Article  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey

    Pınar Kaya Subaşı, Tuba Güler, Fatma Gül Yurdakul & Hatice Bodur

  2. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey

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  1. Pınar Kaya Subaşı
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  2. Tuba Güler
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  3. Fatma Gül Yurdakul
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  4. Şebnem Ataman
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  5. Hatice Bodur
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Correspondence to Tuba Güler.

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Kaya Subaşı, P., Güler, T., Yurdakul, F.G. et al. Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: an electrophysiological and ultrasonographic study. Rheumatol Int 41, 361–368 (2021). https://doi.org/10.1007/s00296-020-04745-8

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  • DOI: https://doi.org/10.1007/s00296-020-04745-8

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