背景:腕管综合征(CTS),正中神经压迫引起的压迫性神经病,是一种可导致生活质量下降的进行性疾病。研究表明CTS与关节炎之间存在关联;然而,以前检查骨关节炎(OA)和CTS的研究数量有限,范围和研究设计。这项研究估计了OA患者中CTS的发生率和风险。整体和特定的关节,在美国一个以人口为基础的大型队列中。
方法:来自Optum索赔数据库的患者年龄≥45岁,在2018年1月1日至2022年12月31日之间诊断为OA,符合OA队列的条件。非OA队列包括在索引日期未诊断为OA且索引前12个月无OA病史的患者。使用倾向评分匹配来平衡基线特征。使用Cox回归估计的发病率和调整后的风险比评估OA和非OA队列中的CTS风险。
结果:应用纳入/排除标准后,诊断为OA的6,023,384名成年人中的3,610,240人仍留在OA队列中。在倾向得分匹配后,每个队列包括1,033,439例个体.每1000人年CTS的发病率在OA队列中为7.35(95%置信区间[CI]7.21-7.49),在非OA队列中为1.44(95%CI1.38-1.50)。OA患者发生CTS的风险约为无OA患者的4倍(风险比=3.80;95%CI3.54-4.07)。在所有OA关节类型中都发现了这种增加的风险,手/手腕的OA具有最高的CTS风险。此外,与单个受影响关节相比,多个OA关节的风险更高.
结论:OA会增加CTS的风险,但这不仅限于手/腕部OA患者,提示OA对CTS的系统性影响。虽然手/腕部OA患者的风险似乎最高,膝关节或髋关节等受影响关节较远的患者发生CTS的风险也增加.
BACKGROUND: Carpal tunnel syndrome (CTS), an entrapment neuropathy caused by pressure of the median nerve, is a progressive condition that can lead to a decreased quality of life. Studies suggest an association between CTS and arthritis; however, previous studies examining osteoarthritis (OA) and CTS are limited in number, scope and study design. This study estimated the incidence and risk of CTS among patients with OA, both overall and by specific joints, in a large population-based cohort in the United States.
METHODS: Patients from the Optum claims database aged ≥ 45 years and diagnosed with OA between January 1, 2018, and December 31, 2022, were eligible for the OA cohort. The non-OA cohort included those without a diagnosis of OA at the index date and no history of OA for 12 months pre-index. Baseline characteristics were balanced using propensity score matching. The risk of CTS in the OA and non-OA cohort were evaluated using incidence rates and adjusted hazard ratios that were estimated using Cox regression.
RESULTS: After applying the inclusion/exclusion criteria, 3,610,240 of the 6,023,384 adults with a diagnosis of OA remained in the OA cohort. After propensity-score matching, each cohort included 1,033,439 individuals. The incidence rates for CTS per 1000 person-years were 7.35 (95% confidence interval [CI] 7.21-7.49) in the OA cohort and 1.44 (95% CI 1.38-1.50) in the non-OA cohort. The risk of developing CTS in patients with OA was ~ 4 times that of patients without (hazard ratio = 3.80; 95% CI 3.54-4.07). This increased risk was found across all OA joint types, with OA of the hand/wrist having the highest risk for CTS. Additionally, multiple OA joints presented a higher risk compared with a single affected joint.
CONCLUSIONS: OA increases the risk of CTS, but this is not limited to patients with hand/wrist OA, suggesting a systemic impact of OA on CTS. While the risk appears highest for patients with hand/wrist OA, patients with more distant affected joints like knee or hip also have an increased risk of CTS.