• Nauman Ismat Butt Azra Naheed Medical College, Superior University Lahore Pakistan
  • Muhammad Bilal Rasheed Azra Naheed Medical College, Superior University Lahore Pakistan
  • Muhammad Sohail Ajmal Ghoauri Bahawal Victoria Hospital, Quaid-e-Azam Medical College Bahawalpur Pakistan
  • Faizan Ali Khan Azra Naheed Medical College, Superior University Lahore Pakistan
  • Fahmina Ashfaq Jinnah Hospital, Allama Iqbal Medical College Lahore Pakistan
  • Aniqa Anser Azra Naheed Medical College, Superior University Lahore Pakistan


Rheumatoid Arthritis, DAS-28 Score, Carpal Tunnel Syndrome, Tinel Sign, Phalen Sign


Background: Rheumatoid arthritis (RA) is an auto-immune inflammatory arthritis globally affecting 1% of the population. This study was conducted to see prevalence of carpal tunnel syndrome in patients of RA and its association with disease severity. Methods: One-hundred-fifty-four patients aged 21?80 years, of both gender, with RA were enrolled using non-probability consecutive sampling technique. Patients were divided into two groups of 77 each: active disease group (DAS-28 score >3.2) and LDA/remission group (DAS-28 score ?3.2). RA was defined according to the 2010 ACR Diagnostic Criteria for Rheumatoid Arthritis. Disease severity of RA was determined according to DAS-28 score. Carpal tunnel syndrome (CTS) was diagnosed clinically by specific symptoms and clinical signs. Data were analysed using SPSS-25. Results: Mean age of the patients was 43.6±13.7 years, 102 (66.3%) were female. Mean disease duration was 8.3±6.1 years, and mean DAS-28 score was 4.3±2.1. RA factor was positive in 98 (63.7%) and Anti-CCP antibody in 79 (51.3%). CTS was present in 49 (31.8%) patients. On stratification, CTS was seen in 32 (41.5%) patients with active disease compared with 17 (22.1%) patients with LDA/remission. No statistical association of CTS was seen with age, gender, disease duration, RA factor positivity, Anti-CCP antibody positivity and disease severity. Conclusion: Carpal Tunnel Syndrome was seen in about one-third patients with RA but no statistically significant association was seen with age, gender, disease duration, RA factor or Anti-CCP positivity and disease activity.

Pak J Physiol 2023;19(4):32–5


Download data is not yet available.


Firestein GS. Pathogenesis of rheumatoid arthritis: The intersection of genetics and epigenetics. Trans Am Clin Climatol Assoc 2018;129:171–82.

Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75(3):291–4.

Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, et al. The association between neutrophil/lymphocyte ratio and disease activity in rheumatoid arthritis and ankylosing spondylitis. J Clin Lab Anal 2016;30(5):597–601.

Karimifar M, Salesi M, Farajzadegan Z. The association of anti-CCP1 antibodies with disease activity score 28 (DAS-28) in rheumatoid arthritis. Adv Biomed Res 2012;1:30.

Butt NI, Ashfaq F, Habib O, Kakar AATK, Arif K, Afzal H. Clinico-demographic differences and severity of rheumatoid arthritis. Professional Med J 2023;30(3):342–7.

Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016;388:2023–38.

Butt NI, Anser A, Ashfaq F, Rasheed MB. Platelet lymphocyte ratio as an inflammatory marker in rheumatoid arthritis. Pak J Physiol 2022;18(4):18–21.

Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013;39(5):495–505.

Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol 2015;29(3):440–53.

Keith MW, Masear V, Chung KC, Maupin K, Andary M, Amadio PC, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am 2009;91(10):2478–9.

DeQuattro K, Imboden JB. Neurologic Manifestations of Rheumatoid Arthritis. Rheum Dis Clin North Am 2017;43(4):561–71.

Smerilli G, Di Matteo A, Cipolletta E, Carloni S, Incorvaia A, Di Carlo M, et al. Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome. Clin Rheumatol 2021;40(3):1085–92.

Subasi KP, Güler T, Yurdakul FG, Ataman ?, Bodur H. Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: an electrophysiological and ultrasonographic study. Rheumatol Int 2021;41(2):361–8.

Karadag O, Kalyoncu U, Akdogan A, Karadag YS, Bilgen SA, Ozbak?r S, et al. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity. Rheumatol Int 2012;32(8):2313–9.

Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford) 2012;51(Suppl 6):vi5–9.

van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol 2016;34(5 Suppl 101):S40–4.

Wipperman J, Goerl K. Carpal tunnel syndrome: diagnosis and management. Am Fam Physician 2016;94(12):993–9.

Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002;113(9):1373–81.

Filippucci E, Gabba A, Di Geso L, Girolimetti R, Salaffi F, Grassi W. Hand tendon involvement in rheumatoid arthritis: an ultrasound study. Semin Arthritis Rheum 2012;41(6):752–60.

Uchiyama S, Itsubo T, Yasutomi T, Nakagawa H, Kamimura M, Kato H. Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2005;76(8):1103–8.

Muller S, Hider S, Machin A, Stack R, Hayward RA, Raza K, et al. Searching for a prodrome for rheumatoid arthritis in the primary care record: A case-control study in the clinical practice research datalink. Semin Arthritis Rheum 2019;48(5):815–20.

Wright AR, Atkinson RE. Carpal Tunnel Syndrome: An Update for the Primary Care Physician. Hawaii J Health Soc Welf. 2019;78(11 Suppl 2):6–10.

Meys V, Thissen S, Rozeman S, Beekman R. Prognostic factors in carpal tunnel syndrome treated with a corticosteroid injection. Muscle Nerve 2011;44(5):763–8.

Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA 2002;288(10):1245–51.




How to Cite

Butt NI, Rasheed MB, Ghoauri MSA, Khan FA, Ashfaq F, Anser A. PREVALENCE OF CARPAL TUNNEL SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ITS ASSOCIATION WITH DISEASE SEVERITY. Pak J Phsyiol [Internet]. 2023 Dec. 31 [cited 2024 Feb. 27];19(4):32-5. Available from: