PMR with Carpal Tunnel Syndrome

[kangaroojohn]

I have an appointment with my (not very engaging ) rheumy on Thursday and would be grateful for our group's comments on the following.

I finnished pred on 12.11.24 and am in my "one year after". I feel reasonable but 4 weeks after stopping I developed symptoms in my right hand (and on one occasion these occured also in my left!) which are as yet undiagnosed, but from here and general on-line reading are probably those of CTS.

I consider these symtoms of CTS are related to my PMR. They are not particularly troublesome at the moment.

I had also had the stiffness in this hand in my early painful phase of PMR prior to starting pred, but it was for 2-3 days only and diasppeared very soon when I wriggled my fingers on waking.

My question is please: Should I just put up with the CTS for the time being and hope it will go away, like the other PMR symtoms did, or should I expect to launch into CTS investigations and treatments straight away?

Thanks again so much if you can help

[PMRpro Ambassador]

I suppose you need to flag it and then be very observant - you know I'm sure that even 1/2mg pred can keep inflammation due to a very low level of disease activity under control but zero is a step too far.

Carpal tunnel can be a thing in its own right - and it can accompany PMR. Either way, a low dose of pred can hide it nicely since it is due to inflammation squeezing the median nerve and the pred will reduce that.

Then the questions crops up as to whether surgery is the right thing for you - or will wrist supports etc do the job well enough. I think you have to ask the question - and if he is not interested and it gets worse, try the next option, your GP I assume?

[kangaroojohn in reply to PMRpro]

Thanks PMRpro for these perspectives. Unless the rheumy has any options I prefer, I plan not to use pred but to find a good fitting splint/support which I will wear at home (especially at night) and I will return to my (sympathetic) GP if I need to.

[PMRpro Ambassador in reply to kangaroojohn]

You don't have to go back to oral pred - a common way of dealing with CTS is a local steroid injection. Sometimes the splint is all you need - or you may eventually need surgery. But you have to wait and see,

[DorsetLady PMRGCAuk volunteer]

There are plenty of related posts now you have asked, and PMRpro has explained it may or may not be related to PMR.

[kangaroojohn in reply to DorsetLady]

Just a quick note to say the rheumy was adamant my PMR and CTS were not related, but as both these conditions are also mainly ladies' (and I am not one) I am not convinced of his view.

[PMRpro Ambassador in reply to kangaroojohn]

Any rheumy who is "adamant" there is no connection about something that is commonly see in PMR needs to have a rethink. I recently heard a doctor say "never say never in medicine"!

Some 30 years ago there were quite a lot of papers looking at the association between CTS and PMR and this much more recent article

emedicine.medscape.com/arti...

mentions CTS is seen in about 15% of patients. I think that is high enough to make a connection.

This

ccjm.org/content/87/9/549

says

" Inflammation may also involve periarticular structures, causing distal tenosynovitis and carpal tunnel syndrome.8 Pitting edema affecting the distal extremities ..."

Tenosynovitis is common in PMR and can contribute to CTS.

[kangaroojohn in reply to PMRpro]

I read the first ref- 15% indeed! So I feel strongly again that my CTS and PMR are quite likely connected. The rheumy did give me referrals for an EMG (for an NCV test?) and also to a hand surgeon, but I feel I could wait before using them to see if the symptoms cease as the other symptoms of PMR.

[DorsetLady PMRGCAuk volunteer in reply to kangaroojohn]

He is correct in that more females than males have GCA and PMR - but not on CTS & PMR ..🤦🏻‍♀️