Arthritis as a risk factor for carpal tunnel syndrome: a meta-analysis

<b>Objectives</b>: The effects of inflammatory and degenerative arthritis on carpal tunnel syndrome (CTS) are not well known. This systematic review and meta-analysis aimed to assess whether rheumatoid arthritis (RA) and osteoarthritis (OA) increase the risk of CTS. <b>Method</b>: Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar, and ResearchGate until January 2015. Twenty-three (five cohort, 10 case control, and eight cross sectional) studies qualified for the meta-analyses. A random-effects meta-analysis was used and heterogeneity and publication bias were assessed. <b>Results</b>: Both RA and OA were associated with CTS. Pooled unadjusted odds ratios (ORs) were 1.91 [95% confidence interval (CI) 1.33–2.75, I² = 55.2%, nine studies, n = 10 688] for arthritis (either inflammatory or degenerative), 2.91 (95% CI 2.33–3.62, I² = 22.3%, 11 studies, n = 74 730) for RA, and 2.13 (95% CI 1.65–2.76, I² = 39.2%, five studies, n = 20 574) for OA of any joint. Pooled confounder-adjusted ORs were 1.96 (95% CI 1.21–3.18, I² = 73.1%, six studies, n = 11 542) for arthritis, 1.96 (95% CI 1.57–2.44, I² = 32.2%, eight studies, n = 72 212) for RA, and 1.87 (95% CI 1.64–2.13, I² = 0%, two studies, n = 19 480) for OA. There was no evidence of publication bias, and excluding cross-sectional studies or studies appraised as having a high risk of selection bias did not change the magnitude of the associations. <b>Conclusions</b>: The findings of this systematic review and meta-analysis suggest that both RA and OA increase the risk of CTS. Further prospective studies on the effect of wrist OA on CTS are needed.

<b>研究目的</b>：目前炎性与退行性关节炎对腕管综合征（carpal tunnel syndrome, CTS）的影响尚不明确。本系统综述与荟萃分析旨在评估类风湿关节炎（rheumatoid arthritis, RA）与骨关节炎（osteoarthritis, OA）是否会提升腕管综合征的发病风险。<b>研究方法</b>：研究于2015年1月前在PubMed、Embase、Web of Science、Scopus、Google Scholar及ResearchGate数据库中开展文献检索。最终共有23项符合纳入标准的研究被纳入本次荟萃分析，其中包含5项队列研究（cohort study）、10项病例对照研究（case control study）及8项横断面研究（cross-sectional study）。本研究采用随机效应模型进行荟萃分析，并对异质性与发表偏倚进行评估。<b>研究结果</b>：类风湿关节炎与骨关节炎均与腕管综合征存在关联。未校正混杂因素的合并比值比（odds ratio, OR）显示，各类关节炎（炎性或退行性）对应的OR值为1.91[95%置信区间（confidence interval, CI）1.33~2.75，I²=55.2%，共9项研究，样本量n=10688]；类风湿关节炎对应的OR值为2.91（95%CI 2.33~3.62，I²=22.3%，共11项研究，n=74730）；任意关节骨关节炎对应的OR值为2.13（95%CI 1.65~2.76，I²=39.2%，共5项研究，n=20574）。校正混杂因素后的合并OR值显示，各类关节炎对应的OR值为1.96（95%CI 1.21~3.18，I²=73.1%，共6项研究，n=11542）；类风湿关节炎对应的OR值为1.96（95%CI 1.57~2.44，I²=32.2%，共8项研究，n=72212）；骨关节炎对应的OR值为1.87（95%CI 1.64~2.13，I²=0%，共2项研究，n=19480）。本研究未发现存在发表偏倚的证据，且剔除横断面研究或被评估为存在高选择偏倚风险的研究后，上述关联的强度未发生显著变化。<b>研究结论</b>：本系统综述与荟萃分析的结果表明，类风湿关节炎与骨关节炎均会提升腕管综合征的发病风险。未来仍需开展针对腕部骨关节炎对腕管综合征影响的前瞻性研究。