Background/Purpose: The compression neuropathies due to arthritis, tenosynovitis and deformities in the joints, mononeuritis multiplex are very common in patients with rheumatoid arthritis (RA). No previous study investigated function and morphology of peripheral nerves in patients with RA. This study was aimed to compare the morphology and electrophysiology of median, ulnar and tibial nerves in patients with RA to healthy controls.

Methods:

Fifteen female patients (20-60 years) were diagnosed with RA at least 1 year before according to ACR criteria and 12 healthy women (matched for age and body mass index) were enrolled. A total of 30 RA patient extremities and 24 healthy controls were included. Patients with an additional disease (diabetes, hypothyroidism, uremia, lyme, sarcoidosis, leprosy, guillain barre syndrome, neurotoxic drug use, etc.), which may be caused by polyneuropathy, were excluded. Disease activity was assessed by using the clinical disease activity index (CDAI), DN4-neuropathic pain questionnaire, with or without neuropathic pain. The patients and the control group were assessed by three independent researchers. After clinical assessment of the clinician (SUD), the patients were referred to the electrodiagnosis laboratory. Nerve conduction studies (NCS) were performed by the same electrodiagnostician (ZO) who was blinded to clinical findings. The patients who had an electrodiagnostic abnormality were excluded. Patients were referred to ultrasonographic assessment, which was done by a third blinded researcher (SSO). In the electronoromyography (ENMG measurement; median (motor and sensory), ulnar (motor and sensory), tibial (motor), and sural (sensory) nerve conduction studies were performed bilaterally .

Results: Sonographic measurements of nerve crossectional area of the median nerve at level of wrist, ulnar nerve at wrist and midpoint of forearm, and cubital tunnel and tibial nerve at the level of the of the both ankle and poplitea were statistically bigger in patient with RA then the control group (p<0.05) (Table 1).. Cubital tunnel syndrome (6 in RA patients, 2 in control group; p<0.05) and carpal tunnel syndrome (4 in RA patints, 2 in control group; p<0.05) were observed significantly more in RA patients than control group in ENMG study.

Conclusion: In summary, there are morphological changes in the peripheral nerves of RA patients, although their functions are not impaired yet. Therefore, it is important to evaluate the peripheral nerves sonographically in RA patients.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-electrophysiologic-and-sonographic-evaluation-of-peripheral-nerves-in-rheumatoid-arthritis-patients/