Role of Ultrasound in Evaluation of Median and Ulnar Nerves in Rheumatoid Arthritis Patients in Correlation with Nerve Conduction Studies

Abstract

Abstract Background Rheumatoid arthritis (RA) is a systemic inflammatory disease of unknown etiology characterized by the involvement of the joints. RA is also associated with vasculopathy, peripheral, autonomic, and entrapment neuropathy. The presence of peripheral neuropathy contributes significantly to the functional limitation in rheumatoid arthritis patients. Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and consists of the compression of the median nerve as it courses through the carpal tunnel followed by the cubital tunnel syndrome which is the most common site for entrapment for the ulnar nerve. Aim of the Work to evaluate the role of ultrasound in evaluation of median and ulnar nerves in rheumatoid arthritis patients in correlation with nerve conduction studies. Patients and Methods to elucidate this aim, 25patients diagnosed with RA, diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for diagnosis of RA. And 25 healthy control subjects (matched for age and body mass index) were enrolled. Results this study was carried on 25 patients, 9 (34.7%) of whom were females, and 17 (68%) were males. The mean age of the studied group was (38.96±6.24 years old). The mean disease duration was 7 ±1.13 years; the mean disease activity index was 4.28 ±0.15. All the studied cases suffer from needle sensation, 24 (96) had numbness and 17(68) had burning sensation. All the studied cases in patient group had distal weakness and negative sensory testing (light touch, pinprick, temperature and vibration). As regarding to extra-articular manifestations, the most common was dry mouth and dry eye in all the studied cases followed by itchy skin in 13(52) patient, then joints aches and subcutaneous nodules in 2(8) patient and purpura was seen in only a case. Conclusion US has the advantage of early detection of median and ulnar nerves neuropathy and can assess the morphology of median and ulnar nerves and its surroundings. US measurements of median and ulnar nerves have a comparable diagnostic value as a non- invasive and an alternative modality for the evaluation of carpal tunnel syndrome and cubital tunnel syndrome.