Carpal Tunnel Syndrome May Signal Early Rheumatoid Arthritis, Study Finds
USA: A large population-based study has revealed that Carpal Tunnel Syndrome (CTS) could serve as an early, yet often overlooked, indicator of rheumatoid arthritis (RA). The research, which examined patterns of CTS before and after RA diagnosis, highlights a potential prodromal phase in which nerve compression symptoms appear before joint inflammation.
The study published in Arthritis Care & Research found that people were over twice as likely to develop carpal tunnel syndrome in the years before being diagnosed with rheumatoid arthritis, and the risk stayed high, about 1.8 times greater, even after the diagnosis.
For this study, Roslin Jose George, Mayo Clinic, Rochester, MN, USA, and colleagues analyzed health data spanning nearly four decades (1980–2019) from residents of a geographically defined U.S. population. They included 1,335 individuals who fulfilled the 1987 ACR classification criteria for RA and compared them with 1,331 individuals without RA, matched for key variables. CTS was identified based on the presence of at least two diagnosis codes, recorded at least 30 days apart.
The following were the key findings of the study:
- CTS was found to be over twice as common in individuals who later developed RA compared to those who did not (13% vs 6%).
- In many cases, CTS was diagnosed at least two years before RA onset, suggesting it may serve as an early warning sign.
- These findings highlight that nerve-related symptoms like CTS can precede joint symptoms in RA.
- After RA diagnosis, patients continued to have a significantly higher risk of developing CTS.
- RA patients had about an 80% increased risk of CTS compared to those without RA, indicating ongoing nerve involvement even after RA is diagnosed.
The study also explored differences based on serological status. Patients with seronegative RA (lacking anti-CCP antibodies) appeared to have a higher risk of developing CTS both before and after their RA diagnosis, though the results did not reach strong statistical significance before RA onset. Post-diagnosis, however, the link between seronegative RA and CTS was more robust. Obesity was another factor associated with an increased risk of CTS in RA patients.
The researchers suggest that clinicians should be aware of CTS not just as a complication of RA but potentially as an early manifestation. “This study supports the idea that carpal tunnel syndrome may be part of the prodromal phase of rheumatoid arthritis,” the authors noted, adding that its presence should prompt careful evaluation for early inflammatory arthritis, especially in high-risk individuals.
These insights may improve early detection strategies and contribute to more timely diagnosis and management of RA, particularly in patients presenting with unexplained CTS.
Reference:
George, R. J., Frechette, N., Oviedo, M., Javed, I., Achenbach, S. J., Lennon, R. J., Kimbrough, B. A., Joerns, E. K., Kronzer, V. L., Gingery, A., Davis, J. M., Crowson, C. S., & Myasoedova, E. Carpal Tunnel Syndrome (CTS) is an Early Underrecognized Feature of Rheumatoid Arthritis (RA): A Population-Based Study of CTS Occurrence Before and After RA Incidence. Arthritis Care & Research. https://doi.org/10.1002/acr.25566
