Department of Internal Medicine Unit of Rheumatology, Hacettepe University, İncesu Caddesi No: 72/2 Ankara, Turkey.
Rheumatol Int. 2012 Aug;32(8):2313-9. doi: 10.1007/s00296-011-1957-0. Epub 2011 May 24.
Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). High frequency ultrasonography (US) is a sensitive and specific method in diagnosis of CTS. This study is aimed to: firstly assess diameter frequency of CTS in RA with US and compare with a control group; secondly, investigate relationship of CTS with disease activity. One hundred consecutive RA patients (women/men: 78/22) fulfilling ACR 1987 RA criteria and 45 healthy controls (women/control: 34/11) were enrolled into study. Disease activity parameters, RA and CTS patient global assessment and health assessment questionnaire (HAQ-DI) were recorded. Both patient and control group were questioned about secondary causes of CTS, and Katz hand diagram, Boston CTS questionnaire and Phalen ve Tinel tests were applied once for each hand. Wrist joint and carpal tunnel were assessed with US grey scale and power Doppler US, then cross-sectional area of median nerve (CSA) was calculated. Patients with median nerve CSA between 10.0 and 13.0 mm(2) were evaluated with electromyography (EMG). CTS was diagnosed if CSA of median nerve >13.0 mm(2) or CTS was shown with NCS. Although there was no difference between RA patients and controls in age, sex, history of DM (+) and goitre, CTS was more frequent in RA group (respectively, 17.0% vs. 4.4%, P = 0.038). In RA group with CTS, age, history of DM, disease duration, HAQ-DI score, CTS patient global score, Boston symptom severity and functional status scores were elevated compared to without CTS [respectively, 57 (36-73) vs. 50 (24-76), P = 0.041; 35.3% vs. 6.0%, P < 0.001; 108 (12-396) months vs. 72 (6-360) months, P = 0.036; 1.93 (0.75-2.87) vs. 1.125 (0-2.75), P = 0.013; 52 (1-97) vs. 25 (0-91), P = 0.001; 2.81 (1.18-4.17) vs. 2.0 (1.0-4.01), P = 0.01; 3.37 (1.37-5.0) vs. 2.25 (1.0-5.0), P = 0.008]. No difference was found between CTS (+) and (-) RA patients in acute phase reactants, disease activity and US findings (P > 0.05). Sensitivity of Katz hand diagram was higher than Tinel and Phalen tests (respectively, 100, 60.0, 66.7%). Boston symptom and functional scores of RA patients with CTS diagnosed by EMG were increased than patients CTS (-) by EMG [respectively, 3.05 (1.90-4.27) vs. 1.55 (1.0-2.90), P = 0.002; 3.25 (1.73-3.82) vs. 1.12 (1.0-2.10), P = 0.008]. CTS frequency in RA was found higher than normal population, especially in patients with additional risk factors of CTS. There was no relationship between CTS and disease activity. CTS group had long disease duration and worse functional status. CTS could be a result of the chronic course in RA. In patient with CSA between 10 and 13 mm(2), Boston CTS questionnaire might give additional idea about CTS.
腕管综合征（CTS）是类风湿关节炎（RA）最常见的关节外表现之一。高频超声（US）是诊断 CTS 的一种敏感和特异的方法。本研究旨在：首先，用 US 评估 RA 患者的 CTS 直径频率，并与对照组进行比较；其次，研究 CTS 与疾病活动度的关系。连续纳入 100 例符合 ACR 1987 年 RA 标准的 RA 患者（女性/男性：78/22）和 45 名健康对照者（女性/对照组：34/11）。记录疾病活动参数、RA 和 CTS 患者的总体评估以及健康评估问卷（HAQ-DI）。对患者和对照组进行了继发性 CTS 病因的询问，并对每只手进行了 Katz 手图、波士顿 CTS 问卷和 Phalen 和 Tinel 试验。用 US 灰度和功率多普勒 US 评估腕关节和腕管，然后计算正中神经的横截面积（CSA）。正中神经 CSA 在 10.0 和 13.0 mm² 之间的患者接受肌电图（EMG）评估。如果正中神经 CSA > 13.0 mm² 或 NCS 显示 CTS，则诊断为 CTS。尽管 RA 患者和对照组在年龄、性别、DM（+）和甲状腺肿病史方面无差异，但 RA 组的 CTS 更为常见（分别为 17.0% vs. 4.4%，P = 0.038）。在有 CTS 的 RA 组中，年龄、DM 病史、疾病持续时间、HAQ-DI 评分、CTS 患者总体评分、波士顿症状严重程度和功能状态评分均高于无 CTS 的患者[分别为 57（36-73）vs. 50（24-76），P = 0.041；35.3% vs. 6.0%，P < 0.001；108（12-396）个月 vs. 72（6-360）个月，P = 0.036；1.93（0.75-2.87）vs. 1.125（0-2.75），P = 0.013；52（1-97）vs. 25（0-91），P = 0.001；2.81（1.18-4.17）vs. 2.0（1.0-4.01），P = 0.01；3.37（1.37-5.0）vs. 2.25（1.0-5.0），P = 0.008]。在急性反应物、疾病活动度和 US 发现方面，CTS（+）和（-）RA 患者之间无差异（P > 0.05）。Katz 手图的敏感性高于 Tinel 和 Phalen 试验（分别为 100、60.0、66.7%）。通过 EMG 诊断 CTS 的 RA 患者的波士顿症状和功能评分高于 EMG 诊断为 CTS（-）的患者[分别为 3.05（1.90-4.27）vs. 1.55（1.0-2.90），P = 0.002；3.25（1.73-3.82）vs. 1.12（1.0-2.10），P = 0.008]。RA 患者的 CTS 频率高于正常人群，尤其是在有 CTS 额外危险因素的患者中。CTS 与疾病活动度之间无关系。CTS 组疾病持续时间较长，功能状态较差。CTS 可能是 RA 慢性病程的结果。在 CSA 在 10 到 13mm² 之间的患者中，波士顿 CTS 问卷可能会提供有关 CTS 的更多信息。
