AB0337 IS THE RADIAL DEVIATION ASSOCIATED WITH MEDIAN NERVE SWELLING IN PATIENTS WITH RHEUMATOID ARTHRITIS?
Authors: Başak Mansçz-Kaplan, Seçil Vural, Figen Ayhan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) and carpal tunnel syndrome (CTS) are known to be associated and also RA may lead to swelling of the median nerve without the presence of CTS. <h3>Objectives</h3> This study was conducted to test the hypothesis that one of the causes of this median nerve swelling may be radial deviation developing after wrist involvement of RA. <h3>Methods</h3> Of a total of 138 cases, 51 that met the inclusion criteria were included in the study. Electroneuromyography (ENMG) was performed on each patient and those with a CTS diagnosis were excluded from the study. Duruöz hand index, visual analog scale and painDETECT questionnaire was performed in clinical assesment. Radiographic measurements including radial inclination angle were performed with radiography. Using ultrasonography, the median nerve cross-sectional areas (CSAs) of the patients were measured from the four levels of the distal 1/3 of the forearm, radioulnar joint, pisiform bone and hook of hamate, and the ulnar nerve CSAs were measured from the pisiform bone. <h3>Results</h3> The study completed with 102 hands of 51 patients. 27% of these RA patients without clinical and electrophysiological findings were diagnosed as CTS by ultrasonography. A negative correlation was found between the radial inclination (RI) and the median CSAs measured from the radioulnar joint (R: - 0.49; p: 0.00), the pisiform bone (R: - 0.45; p: 0.00), and hook of hamate (R: - 0.60, p: 0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with a low RI at these levels (p &lt; 0.001). <h3>Conclusion</h3> The median nerve CSAs increased as the radial deviation increased in RA patients. The prevention of disease progression may prevent the increase in median nerve CSA by preventing deviations in patients with RA. And the development of CTS may also be prevented. <h3>References</h3> [1] Yagci I, Akdeniz Leblecicier M, Mansiz Kaplan B, Ozturk Gokbakan D, Akyuz G. Sonographic measurements can be misleading for diagnosis carpal tunnel syndrome in patients with rheumatoid arthritis. Acta Reumol Port. 2016;41:40-4 [2] Joshua Broder. Diagnostic imaging for the emergency physician. Elsevier Healh Science. Philadelphia, 2011; page 783. [3] Ito J, Koshino T, Okamoto R, Saito T. Radiologic Evaluation of the rheumatoid hand after synovectomy and extensor carpi radialis longus transfer to extensor carpi ulnaris. J Hand Surg Am. 2003;28(4):585-90. [4] Hammer BH, Hovden IA, Haavardsholm EA, Kristian Kvien T. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology (Oxford). 2006;45(5):584-588. [5] Hammer BH, Haavardsholm EA, Kristian Kvien T. Ultrasonographic measurement of the median nerve in patients with rheumatoid arthritis without symptoms or signs of carpal tunnel syndrome. Ann Rheum Dis. 2007;66:825-7 [6] Sakthiswary R, Singh R. Has the median nerve involvement in rheumatoid arthritis been overemphasized? Rev Bras Reumol. 2017;57(2):122,128. <h3>Disclosure of Interests</h3> None declared