People with two autoimmune diseases, rheumatoid arthritis (RA) and Sjögren’s syndrome, are at an increased risk of developing carpal tunnel syndrome (CTS), according to researchers at the Taipei Veterans General Hospital Department of Physical Medicine and Rehabilitation. These researchers also note that these patients should be screened for CTS and made aware of the risk, though the relationship between CTS and autoimmune diseases remains unclear.
RA is a known risk factor for developing CTS, but physicians still do not know its exact role. CTS involves compression of the median nerve through the wrist at the carpal tunnel. Its symptoms include pain, tingling, and numbness in the fingers. To explore the relationship between CTS and common autoimmune diseases, the researchers conducted a cohort study focusing on autoimmune rheumatic disease (ARD) and inflammatory bowel disease (IBD) patients.
“Patients with autoimmune diseases may be considered with variable conditions, including the involvement of the peripheral nerve system. Yet there were only suspicions regarding ARD/IBD and CTS due to a lack of a large-scale cohort study to verify. This study provides the epidemiological evidence to support the correlation,” said Po-Cheng Hsu, MD, the study’s coauthor.
“Carpal tunnel syndrome is a disease that may affect health-related quality of life. Early diagnosis when managing patients with RA and Sjögren’s syndrome with adequate early health education and treatment could decrease the influence of CTS,” said Hsu.
The researchers used patient records from the 2015 Longitudinal Health Insurance Database of Taiwan’s National Health Insurance Research Database. They identified all of the patients who were diagnosed and enrolled with either ARD or IBD. Next, they calculated the incidence rate and surgical rate of CTS among patients with individual disease. They also analyzed the hazard ratio on comparison of age-matched and gender-matched control groups.
The study included 3,291 patients, including 2,591 females and 701 males who were identified and compared with controls. The incidence rate of CTS was the highest in patients with Crohn’s disease, followed by scleroderma and RA. The incidence rate of CTS in the control group was 4.8%.
After they adjusted the data for age and sex, the researchers observed a significant increase in the hazard ratio for developing CTS in patients with Sjögren’s syndrome and RA. Overall, the rate of surgery, a treatment for CTS that does not improve with splinting or medications, was 0.2% in the ARD or IBD patients and 0.3% in the control group.
The study suggests that people with Sjögren’s syndrome and RA have an increased risk of CTS compared to the general population and that screening for CTS in patients with these autoimmune diseases may be warranted.
“These findings provide information that clinical practitioners and patients may keep in mind: the classical symptoms of numbness, tingling, and paresthesia may be related to CTS,” Hsu said. “The surgery rate in ARB/IBD seems to be no different from that in the general population, suggesting that they were not at risk for developing severe CTS. We will further investigate the therapeutic effects of different injection methods, but our research will not be limited to the patients with RA or Sjögren’s syndrome.”
The study was presented at the Association of Academic Physiatrists Annual Meeting, February 19 through February 23, in Puerto Rico.
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