Is Carpal Tunnel an Early Sign of Rheumatoid Arthritis?

Medscape

07-05-2025

TOPLINE:
Carpal tunnel syndrome (CTS) appeared more than twice as frequently in patients before rheumatoid arthritis (RA) diagnosis than in those without RA, suggesting that CTS could serve as an early indicator for RA risk.
METHODOLOGY:
Researchers conducted a population-based study using the Rochester Epidemiology Project, which provides comprehensive longitudinal health information from Olmsted County, Minnesota.
Analysis included 1335 patients with RA meeting the 1987 American College of Rheumatology classification criteria between 1980 and 2019.
Patients with RA were matched 1:1 with 1331 control individuals.
Investigators identified CTS cases through two or more diagnosis codes occurring at least 30 days apart.
TAKEAWAY:
A total of 13% of individuals who developed RA were diagnosed with CTS prior to or at the onset of RA compared with 6% in non-RA individuals (odds ratio [OR], 2.23; 95% CI, 1.69-2.94).
In patients with RA, most CTS diagnoses occurred at least 2 years before the onset of RA.
Patients with RA were also at an increased risk for CTS following the onset of RA (hazard ratio [HR], 1.78; 95% CI, 1.38-2.30).
Obesity (HR, 1.42; 95% CI, 1.02-1.99) and seronegativity for anti–cyclic citrullinated peptide antibodies (HR, 1.79; 95% CI, 1.07-2.99) were associated with increased risk for CTS in the RA group.
IN PRACTICE:
'Increased vigilance is needed in individuals with CTS regarding the risk of developing RA. Referral to a rheumatologist can be considered, particularly in persistent and severe forms of CTS (eg, patients requiring carpal tunnel release surgery), that are not otherwise explained by traditional risk factors (eg, obesity, hypothyroidism, [diabetes mellitus]) and regardless of serostatus,' wrote the authors of the study.
SOURCE:
This study was led by Roslin Jose George, MBBS, MPH, of the Mayo Clinic in Rochester, Minnesota. It was published online in Arthritis Care & Research on May 5, 2025.
LIMITATIONS:
This study population was predominantly White from Olmsted County and surrounding areas in Minnesota, potentially limiting generalizability to more diverse populations. The researchers used code-based definitions for CTS ascertainment, which may have introduced healthcare utilization bias as patients with milder CTS might not seek medical care. Additionally, information about unilateral vs bilateral CTS and detailed joint count scores was not collected during the record review, which could have provided better understanding of CTS severity and its association with RA.
DISCLOSURES:
This study received funding from grants provided by the National Institutes of Health, National Institute of Arthritis, Musculoskeletal and Skin Diseases, and National Institute on Aging. The Rochester Epidemiology Project medical records-linkage system was supported by the National Institute on Aging, Mayo Clinic Research Committee, and user fees.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.