Yonsei Med J.  2015 Jul;56(4):1015-1020. 10.3349/ymj.2015.56.4.1015.

Carpal Tunnel Syndrome in Behcet's Disease

• Lee J
• Cho S
• Kim DY
• Zheng Z
• Park H
• Bang D

• KMID: 2366343
• DOI: http://doi.org/10.3349/ymj.2015.56.4.1015

Abstract

PURPOSE
Behcet's disease (BD) is a chronic inflammatory disease characterized by orogenital ulcers, skin and ocular lesions, in addition to articular, vascular, and neurologic symptoms. Carpal tunnel syndrome (CTS), can also occur in BD patients secondary to inflammation in the connective tissues, vessels, and tendons, as well as nerve involvement in BD itself. However, reports of patients who have CTS in BD are rare. The aim of this study was to evaluate the clinical characteristics of CTS in BD patients.
MATERIALS AND METHODS
Retrospective analysis of the medical records of 1750 BD patients, and 14 (0.8%) BD patients who were diagnosed with CTS was performed at the BD Specialty Clinic of Severance Hospital. Patient demographics, disease activity/severity for both diseases, and the clinical characteristics of CTS in BD were recorded and analyzed.
RESULTS
All 14 BD patients with CTS were women. Twelve patients (85.7%) were diagnosed with active BD. The CTS was mild in 8 patients (57.2%), moderate in 3 patients (21.4%), and severe in 3 patients (21.4%). Ten patients (71.4%) had BD prior to the diagnosis of CTS, and these 10 patients all had active BD.
CONCLUSION
CTS can occur as a result of the inflammation associated with BD and can also be the presenting symptom of nerve involvement in BD. CTS can also develop as the initial symptom of BD. Therefore, a higher degree of suspicion should be maintained for CTS in patients with BD and vice versa; however, the exact relationship is uncertain.

Keyword

Behcet's disease; carpal tunnel syndrome

MeSH Terms

Adult
Age Distribution
Aged
Behcet Syndrome/complications/diagnosis/*epidemiology
Carpal Tunnel Syndrome/diagnosis/*epidemiology
Female
Humans
Inflammation
Male
Middle Aged
Retrospective Studies
Sex Distribution

Reference

1. James DG. Behcet's syndrome. N Engl J Med. 1979; 301:431–432. PMID: 460347.

2. Siva A, Altintas A, Saip S. Behçet's syndrome and the nervous system. Curr Opin Neurol. 2004; 17:347–357. PMID: 15167071.

3. Atasoy HT, Tunc TO, Unal AE, Emre U, Koca R, Esturk E, et al. Peripheral nervous system involvement in patients with Behçet disease. Neurologist. 2007; 13:225–230. PMID: 17622917.

4. Akbulut L, Gur G, Bodur H, Alli N, Borman P. Peripheral neuropathy in Behçet disease: an electroneurophysiological study. Clin Rheumatol. 2007; 26:1240–1244. PMID: 17149536.

5. Onder M, Gürer MA. The multiple faces of Behçet's disease and its aetiological factors. J Eur Acad Dermatol Venereol. 2001; 15:126–136. PMID: 11495519.

6. Siva A, Kantarci OH, Saip S, Altintas A, Hamuryudan V, Islak C, et al. Behçet's disease: diagnostic and prognostic aspects of neurological involvement. J Neurol. 2001; 248:95–103. PMID: 11284141.

7. Kidd D, Steuer A, Denman AM, Rudge P. Neurological complications in Behçet's syndrome. Brain. 1999; 122(Pt 11):2183–2194. PMID: 10545402.

8. Akman-Demir G, Baykan-Kurt B, Serdaroglu P, Gürvit H, Yurdakul S, Yazici H, et al. Seven-year follow-up of neurologic involvement in Behçet syndrome. Arch Neurol. 1996; 53:691–694. PMID: 8929179.

9. Namer IJ, Karabudak R, Zileli T, Ruacan S, Küçükali T, Kansu E. Peripheral nervous system involvement in Behçet's disease. Case report and review of the literature. Eur Neurol. 1987; 26:235–240. PMID: 3595663.

10. Lannuzel A, Lamaury I, Charpentier D, Caparros-Lefebvre D. Neurological manifestations of Behçet's disease in a Caribbean population: clinical and imaging findings. J Neurol. 2002; 249:410–418. PMID: 11967645.

11. Akbulut L, Gur G, Bodur H, Alli N, Borman P. Peripheral neuropathy in Behçet disease: an electroneurophysiological study. Clin Rheumatol. 2007; 26:1240–1244. PMID: 17149536.

12. Birol A, Ulkatan S, Koçak M, Erkek E. Peripheral neuropathy in Behçet's disease. J Dermatol. 2004; 31:455–459. PMID: 15235183.

13. Kim HA, Choi KW, Song YW. Arthropathy in Behçet's disease. Scand J Rheumatol. 1997; 26:125–129. PMID: 9137328.

14. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004; 51:642–651. PMID: 15334439.

15. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci. 2010; 15:1–13. PMID: 20151245.

16. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet. 1990; 335:1078–1080. PMID: 1970380.

17. Kurokawa MS, Yoshikawa H, Suzuki N. Behçet's disease. Semin Respir Crit Care Med. 2004; 25:557–568. PMID: 16088499.

18. The British Society For Surgery of The Hand. Evidence for Surgical Treatment 1 (BEST 1) Carpal Tunnel Syndrome (CTS). England: Lincoln's Inn Fields, London, British Society for Surgery of the Hand;2011. accessed on 2014 July 15. Available at: http://www.bssh.ac.uk/education/guidelines/carpal_tunnel_syndrome.pdf.

19. Cho SB, Cho S, Bang D. New insights in the clinical understanding of Behçet's disease. Yonsei Med J. 2012; 53:35–42. PMID: 22187230.

20. Sakane T, Takeno M, Suzuki N, Inaba G. Behçet's disease. N Engl J Med. 1999; 341:1284–1291. PMID: 10528040.

21. Kalayciyan A, Zouboulis C. An update on Behsçet's disease. J Eur Acad Dermatol Venereol. 2007; 21:1–10. PMID: 17207160.

22. Bongers FJ, Schellevis FG, van den Bosch WJ, van der Zee J. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors. Br J Gen Pract. 2007; 57:36–39. PMID: 17244422.

23. Street ER, Eastwood GL, Royle SG. Staged release of bilateral carpal tunnel syndrome: cancellation rates of the second side procedure. J Hand Surg Eur Vol. 2013; 38:552–553. PMID: 23172822.

24. Budak F, Efendi H, Apaydin R, Bilen N, Komsuoglu S. The F response parameters in Behçet's disease. Electromyogr Clin Neurophysiol. 2000; 40:45–48. PMID: 10782357.

25. Pirzada NA, Medell M, Ali II. Colchicine induced neuromyopathy in a patient with normal renal function. J Clin Rheumatol. 2001; 7:374–376. PMID: 17039178.

26. Altiparmak MR, Pamuk ON, Pamuk GE, Hamuryudan V, Ataman R, Serdengecti K. Colchicine neuromyopathy: a report of six cases. Clin Exp Rheumatol. 2002; 20(4 Suppl 26):S13–S16. PMID: 12371628.

27. Dalvi SR, Yildirim R, Yazici Y. Behcet's Syndrome. Drugs. 2012; 72:2223–2241. PMID: 23153327.

28. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008; CD001552. PMID: 18843618.

29. Melikoglu M, Uysal S, Krueger JG, Kaplan G, Gogus F, Yazici H, et al. Characterization of the divergent wound-healing responses occurring in the pathergy reaction and normal healthy volunteers. J Immunol. 2006; 177:6415–6421. PMID: 17056573.

30. Yazici H, Yurdakul S, Hamuryudan V. Behçet disease. Curr Opin Rheumatol. 2001; 13:18–22. PMID: 11148711.