Assessment of neurophysiologic changes and disease activity in patients with chronic rheumatoid arthritis

The involvement of the peripheral nervous system is not uncommon in rheumatoid arthritis [RA]; the most common disorders are multiple mononeuritis, sensor motor neuropathy, and entrapment neuropathy. Several auto-antibodies are associated with the disease, but of the most important are the anti-cyclic citrullinated peptide [anti-CCP] antibodies. However, little is known, about the role of high sensitive C-reactive protein [Hs-CRP] in relation to disease activity in RA. The objectives were to look for the frequency of peripheral nerves involvement in chronic rheumatoid arthritis patients and to investigate the correlations between clinical, hematological, serological, and neurophysiologic findings. This study involved 48 patients with rheumatoid arthritis and 30 apparently healthy subjects as controls. Neurophysiologic assessment was performed for each patient and control subjects and the ELISA method was used for the quantitative measurement of serum anti-CCP antibodies and Hs-CRP concentrations by using special kits. The mean duration of the disease was 6.76 +/- 0.795 years, the mean DAS28 for RA patients was 5.22 +/- 0.131, and the mean HAQ score was 1.00 +/- 0.06. Thirty-three [68.8%] of 48 cases with RA exhibited an electrophysiological evidence of neuropathy [ies]: 14 [29.2%] patients with carpal tunnel syndrome [CTS], 9 [18.8%] patients with polyneuropathy, while 5 [10.4%] patients showed mononeuritis multiplex. There were highly significant increases in the mean values of serum anti-CCP antibody concentration [22.61 +/- 2.34 Vs 5.47 +/- 0.42 U/ml, P0.001], serum Hs-CRP concentration [10.05 +/- 0.64 Vs 2.81 +/- 0.22 mg/1, P0.001], and ESR [41.85 +/- 2.7 Vs 11.73 +/- 1.3 mm/hr, P0.001] in the RA group compared to the control group. In patients with RA, significant negative correlations were observed between anti-CCP antibody concentration and sural nerve velocity [r = - 0.233, P < 0.05] while significant positive correlation was found between anti-CCP antibody concentration with sural latency [r=0.231, P0.05]. The serum Hs-CRP level significantly positively correlated with the Stanford disability index [r=0.324, P0.05], number of tender joint [r-0.296, P0.05], and ESR [r-0.436, p0.0l]. The commonest neurophysiologic abnormalities were carpal tunnel syndrome [CTS], followed by polyneuropathy. Serum anti-CCP antibodies concentration, serum Hs-CRP concentration, and disability index [DI] are significantly correlated with neuropathy and occurrence of neuropathy depends on the activity and/ or severity of rheumatoid arthritis

Carpal tunnel syndrome and associated entrapment mononeuropathies

This study was carried out to assess the electroneurophysiological findings and associated entrapment mononeuropathies in cases of carpal tunnel syndrome [C.T.S.]. One hundred and fifty patients [122 females and 28 males] with clinical suspicion of C.T.S. were included in the study. A questionnaire containing all important information was completed for each case. Nerve conduction study for median nerves and other peripheral nerves was performed according to criteria of Hull Royal Infirmary, using computerized EMG machine. About 80% of referred cases were in the age range of 21-50 years and 70% of them had symptoms for less than 2 years, 120 [80%] of referred cases showed positive C.T.S., 108 [72%] of positive cases had right C.T.S. whereas 44% had left C.T.S. The most common associated entrapment mononeuropathies were right and/or left ulnar tunnel syndrome [U.T.S.]. All those with right U.T.S. were right handed, in addition to that 7% of right handed patients had left U.T.S. Entrapment of other peripheral nerves were also reported but at different rates. Parasthesia / numbness of hand [s] was the major presenting symptom and 58% of positive cases had symptoms other than those of C.T.S.. Out of 99 positive females, 79 were housewives and 33% of positive males were building constructors. Major peripheral nerves are liable to compression in some points along their course. Many occupations may affect more than one peripheral nerve, rendering them vulnerable to entrapment. When performing Nerve Conduction Studies [N.C.S.] for suspected cases with C.T.S., it is important to do N.C.S. for other nerves to confirm or exclude their entrapment