Carpal Tunnel Syndrome Risk Elevated Before and After Rheumatoid Arthritis Diagnosis, Study Finds
A population-based study spanning nearly four decades has found that patients with rheumatoid arthritis (RA) are significantly more likely to develop carpal tunnel syndrome (CTS) both before and after the onset of RA. The results suggest that CTS may be an early musculoskeletal manifestation in the RA disease continuum and that RA increases ongoing CTS risk, with implications for surveillance and management.
Researchers analyzed data from 1,335 patients meeting the 1987 ACR classification criteria for RA between 1980 and 2019 and compared them 1:1 with 1,331 matched individuals without RA. CTS was identified using at least two diagnostic codes at least 30 days apart. The cumulative incidence of CTS was assessed while adjusting for the competing risk of death. Regression models adjusted for age, sex, calendar year, smoking, obesity, diabetes mellitus, and hypothyroidism.
Before or at the time of RA incidence, 13% of patients with RA had CTS compared to 6% of individuals without RA, yielding an odds ratio (OR) of 2.23 (95% CI 1.69–2.94). Most of these CTS cases occurred at least two years before RA diagnosis.
“Most previous incidences of CTS occurred ≥2 years before the index date,” the authors noted, with 112 events among patients with RA versus 75 among controls. This finding supports the hypothesis that CTS may serve as a prodromal feature in RA pathogenesis.
After RA incidence, the risk of developing CTS remained elevated. The hazard ratio (HR) for CTS in patients with RA compared to non-RA individuals was 1.78 (95% CI 1.38–2.30), indicating an approximately 80% increased risk post-diagnosis.
When stratified by serologic status, patients with seronegative RA showed numerically higher CTS risk both before and after RA incidence, although not all findings reached statistical significance. The OR for CTS before diagnosis in seronegative versus seropositive patients was 1.33 (95% CI 0.96–1.84), and the HR after diagnosis was 1.37 (95% CI 0.99–1.88).
In multivariable models focused on patients with RA, two risk factors were significantly associated with post-diagnosis CTS: obesity (HR 1.42, 95% CI 1.02–1.99) and seronegative cyclic citrullinated peptide (CCP) antibody status (HR 1.79, 95% CI 1.07–2.99). Other variables, including diabetes and hypothyroidism, did not show independent associations in this RA-specific analysis.
“We found a more than two-fold increase in risk of CTS in the years preceding RA and a 1.8-fold increased risk of incident CTS following RA onset,” the study concluded.
For practicing rheumatologists, these findings highlight CTS as a potential early indicator of inflammatory arthritis and as a comorbidity requiring continued attention in RA management. Awareness of increased CTS risk—particularly in seronegative and obese patients—may aid in earlier intervention and prevention of functional impairment. Clinicians are encouraged to monitor for symptoms and consider diagnostic testing for CTS both before and after RA diagnosis, especially in at-risk subgroups.
Reference
George RJ, Frechette N, Oviedo M, et al. Carpal tunnel syndrome as an early underrecognized feature of rheumatoid arthritis: a population-based study of carpal tunnel syndrome occurrence before and after rheumatoid arthritis incidence. Arthritis Care Res (Hoboken). Published online May 5, 2025. doi:10.1002/acr.25566
