Arthritis can be defined as inflammation of the joint or joints resulting in pain and disability, joint swelling, and stiffness. On the other hand, carpal tunnel syndrome is a common mononeuropathy which is due to the entrapment of median nerve at the wrist. Arthritis, as mentioned in the definition, is due to the inflammation of one or more joints and it has systemic manifestations. But carpal tunnel syndrome (CPS) is secondary to the compression of median nerve inside the carpal tunnel, and there is no any associated inflammation. CPS does not have any systemic manifestations. This is the key difference between arthritis and CPS.
CONTENTS
1. Overview and Key Difference
2. What is Arthritis
3. What is Carpal Tunnel Syndrome
4. Similarities Between Arthritis and Carpal Tunnel Syndrome
5. Side by Side Comparison – Arthritis vs Carpal Tunnel Syndrome in Tabular Form
6. Summary
What is Arthritis?
Arthritis can be defined as inflammation of the joint or joints resulting in pain and disability, joint swelling, and stiffness. It can be due to numerous causes such as infection, trauma, degenerative changes or metabolic disorders. Different types of arthritis have been described according to the peculiar characteristics seen in each category.
Osteoarthritis
Osteoarthritis is the commonest type of arthritis. It occurs as a result of the damages to the articular cartilage induced by a complex interaction of genetic, metabolic, biochemical and biomechanical factors. This gives rise to an inflammatory response affecting the cartilage, bone, ligaments, menisci, synovium, and capsule.
Usually, the incidence of osteoarthritis before 50 is uncommon but not unheard of. With the advancing age, some radiological evidence will appear indicating the likelihood of getting osteoarthritis in the future.
Predisposing Factors
- Obesity
- Heredity
- Polyarticular OA is more common in women
- Hypermobility
- Osteoporosis
- Trauma
- Congenital joint dysplasia
Clinical Features
- Mechanical pain with movement and/or loss of function
- Symptoms are gradual in onset and progressive
- Short-lived morning joint stiffness
- Functional limitation
- Crepitus
- Bony enlargement
Investigations and Management
On blood testing, ESR is usually normal, but CRP level is slightly elevated. X-rays are abnormal, only in the advanced disease. MRI can observe early cartilage injury and meniscal tears.
During the management of osteoarthritis, the aim is to treat the symptoms and disability, not the radiological appearances. Pain, distress, and disability can be reduced, and proper patient education can increase compliance with the treatment of the disease and its effects.
Rheumatoid Arthritis
Rheumatoid arthritis is a type of inflammatory arthritis that causes synovial inflammation. It presents with inflammatory symmetrical polyarthritis. Rheumatoid arthritis is an autoimmune disease where auto antibodies are produced against IgG and citrullinated cyclic peptide.
The typical presentation of rheumatoid arthritis includes a progressive, symmetrical, peripheral polyarthritis which occurs over a period of a few weeks or months in patients between 30 and 50 years of age. Most of the patients complain of pain and stiffness of small joints of the hands (metacarpophalangeal, proximal interphalangeal) and feet (metatarsophalangeal). Distal interphalangeal joints are usually spared.
Diagnosis of RA can be made based on the clinical observations. NSAIDs and analgesics are used in the management of the symptoms. If synovitis persists beyond six weeks, try to induce remission with intramuscular depot methylprednisolone 80-120mg. If synovitis recurs, the administration of Disease Modifying Anti-Rheumatic Drugs (DMARDs) should be considered.
Spondyloarthritis
Spondyloarthritis is a collective term that is used to describe several conditions which affect the spine and peripheral joints with familial clustering and a link to type 1 HLA antigen. Ankylosing spondylitis, psoriatic arthritis, reactive arthritis, post-dysenteric reactive arthritis and enteropathic arthritis are included in this category.
Clinical Features of ankylosing spondylitis;
- Back pain
- Pain in one or both buttocks
- Retention of the lumbar lordosis during spinal flexion
Regular NSAIDs to improve the signs and symptoms and morning exercises aiming at the maintenance of the spinal morbidity, posture and chest expansion are often required in the management of the disease.
Figure 01: Arthritis
Clinical Features of Psoriatic Arthritis;
- Mono- or oligoarthritis
- Polyarthritis
- Spondylitis
- Distal interphalangeal arthritis
- Arthritis mutilans
What is Carpal Tunnel Syndrome?
This is a common mononeuropathy which is due to the entrapment of median nerve at the wrist. Although it is not associated with any underlying disease most of the time, carpal tunnel syndrome can be seen as a manifestation of the following conditions also.
- Hypothyroidism
- Pregnancy (especially in the third trimester)
- Acromegaly
- Rheumatoid disease
Clinical Features
- Nocturnal tingling in hand or/and forearm. The pain is usually a delocalized one
- Weakness and wasting of the thenar muscles
- Passive maximal wrist flexion provokes pain
- A tingling sensation occurs when the flexor aspect of the wrist is tapped
Figure 02: Carpal Tunnel Syndrome
Management
- Steroid injection or strapping a splint can minimize the symptoms in mild cases
- Surgical decompression of the carpal tunnel is the definitive treatment
- In pregnancy the condition is self-limiting
What is the Similarity Between Arthritis and Carpal Tunnel Syndrome?
- Both conditions are associated with a troublesome pain and discomfort.
What is the Difference Between Arthritis and Carpal Tunnel Syndrome?
Arthritis vs Carpal Tunnel Syndrome |
|
| Arthritis can be defined as inflammation of the joint or joints resulting in pain and/or disability, joint swelling, and stiffness. | This is a common mononeuropathy which is due to the entrapment of median nerve at the wrist. |
| Cause | |
| Arthritis is due to the inflammation of a joint. | Carpal tunnel syndrome is due to the compression of median nerve during its passage through the carpal tunnel. |
| Disease Type | |
| Arthritis is a systemic disease | Carpal tunnel syndrome per say is not a systemic disease but can be a manifestation of systemic diseases such as hypothyroidism, rheumatoid arthritis, and acromegaly. |
| Clinical Features | |
| Clinical features of arthritis vary according to the variant that the patient is having. But joint pain, swelling, tenderness and morning stiffness are the common features found in most of the forms of arthritis. | Clinical features of carpal tunnel syndrome are,
· Nocturnal tingling in hand or/and forearm. The pain is usually a delocalized one · Weakness and wasting of the thenar muscles · Passive maximal wrist flexion provokes pain · A tingling sensation occurs when the flexor aspect of the wrist is tapped |
| Management | |
| Steroids and DMARDS are the mainstays in the management of arthritic diseases. | Albeit the steroids can minimize the symptoms of carpal tunnel syndrome, definitive management is via surgical decompression of the nerve |
Summary – Arthritis vs Carpal Tunnel Syndrome
Arthritis can be defined as inflammation of the joint or joints resulting in pain and/or disability, joint swelling, and stiffness. This is a common mononeuropathy which is due to the entrapment of median nerve at the wrist. Although arthritis is a systemic disease, carpal tunnel syndrome is not a systemic disease. This is the difference between the two disorders.
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Reference:
1. Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2009.
Image Courtesy:
1.’Rheumatoid-Arthritis’By National Library Of Medicine US, (Public Domain) via Commons Wikimedia
2.’Carpal Tunnel Syndrome’By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work, (CC BY 3.0) via Commons Wikimedia