Gu, Alex

Howard, Peter

Narain, Sasha

O’Malley,

Ranson, Rachel

Thakkar,

Zhao, Amy

English

George Washington University: Health Sciences Research Commons (HSRC)

Background & Methods• Immunoglobulin light chain and transthyretin systemic amyloidoses are diseases of improper protein folding that can result in the accumulation of proteins in the soft tissues• Accumulation of these proteins in the carpal tunnel can result in carpal tunnel syndrome (CTS), a compressive neuropathy of the median nerve• The aim of this study was to investigate which patient specific factors in those diagnosed with CTS suggest that the compression may be due to accumulation of amyloid proteins, as evidenced by a later diagnosis of amyloidosis.Pearson chi-squared analysis of comorbidities in Amyloid vs Non amyloid groupsConclusionThis study demonstrates that amongst all patients presenting with CTS, those who are men aged 60 or older, women aged 45-59, or who present with additional comorbidities including lymphoma, pulmonary circulation diseases, coagulopathy, and cardiac comorbidities are more likely to later be diagnosed with amyloidosis. Presence of these patient demographics may suggest that the CTS symptoms are caused by amyloid protein deposits in the carpal tunnel. This may lead physicians to consider obtaining a biopsy in this population to potentially diagnose a patient’s amyloidosis prior to the development of end organ symptoms. Implementation of this strategy offers the opportunity for early diagnosis and intervention of systemic amyloidoses, improving patient health and safety, and reducing economic burden on the healthcare system.Amyloidosis and Carpal Tunnel Syndrome: A Database Study of Associated Risk Factors and ComorbiditiesSasha Narain, Amy Zhao, Peter Howard, Rachel Ranson, Alex Gu, Thakkar, O’MalleyTotal Male Femalen % n %Total 1071 595 476GenderMale 595 595 0Female 476 0 476Age*40 to 44 21 7 33.33% 14 66.67%45 to 49 54 22 40.74% 32 59.26%50 to 54 102 36 35.29% 66 64.71%55 to 59 172 80 46.51% 92 53.49%60 to 64 213 122 57.28% 91 42.72%65 to 69 248 152 61.29% 96 38.71%70 to 74 357 214 59.94% 143 40.06%75 to 79 357 208 58.26% 149 41.74%80 to 84 206 125 60.68% 81 39.32%Control Cohort Amyloidosis Cohortn % n % P-value†Comorbidity* 689975 1071Congestive Heart Failure 3519 0.51% 18 1.68% <0.001Arrhythmias 7879 1.14% 23 2.15% 0.018Valvular Disease 4760 0.69% 12 1.12% 0.309Pulmonary Circulation Disorders 1725 0.25% 7 0.65% <0.001Peripheral Vascular Disease 5188 0.75% 16 1.49% 0.041Hypertension 14558 2.11% 39 3.64% <0.001Paralysis 568 0.08% 3 0.28% 1.000Other neurological disorders 1832 0.27% 4 0.37% 0.725Chronic Pulmonary Disease 7927 1.15% 19 1.77% 0.097Hypothyroidism 5834 0.85% 14 1.31% 0.394Chronic Kidney Disease 3926 0.57% 20 1.87% <0.001Liver Disease 2886 0.42% 10 0.93% 0.003Peptic Ulcer Disease 529 0.08% 0 0.00% <0.001Lymphoma 7947 1.15% 57 5.32% <0.001Cancer Met 21189 3.07% 83 7.75% <0.001Cancer No Met 97934 14.19% 274 25.58% <0.001Rheumatoid Arthritis and Collagen Vascular Disease 4704 0.68% 15 1.40% 0.053Coagulopathy 67823 9.83% 254 23.72% <0.001Fluid and electrolyte disorders 6806 0.99% 25 2.33% <0.001Blood loss anemia 1102 0.16% 2 0.19% 1.000Deficiency anemia 3944 0.57% 16 1.49% 0.003Alcohol abuse 9939 1.44% 12 1.12% 0.476Drug abuse 86778 12.58% 104 9.71% 0.036Psychoses 27454 3.98% 41 3.83% 0.231Depression 315458 45.72% 457 42.67% 0.010Obesity 2452 0.36% 5 0.47% 0.613Smoking 2565 0.37% 3 0.28% 0.860Osteoporosis 57533 8.34% 111 10.36% 0.069Diabetes 5957 0.86% 17 1.59% 0.018Vitamin D Deficiency 139820 20.26% 221 20.63% 0.580Dementia 5555 0.81% 13 1.21% 0.319Table 1: Incidence of amyloidosis in patients with CTS by age and gender*Age groupings represent patient age at the time of CTS diagnosis.Table 2: Comorbidities of patients with CTS with or without later diagnosis of amyloidosis.*Comorbidities are analyzed at time of carpal tunnel syndrome diagnosis. †All p values are for comparisons between the group of interest and the control group; bolding indicates significance of p < 0.05.Results . AcknowledgementsThis research is the result of collaboration across George Washington University, Johns Hopkins University, and Virginia Commonwealth University through the Orthopedic Research CollaborativePearl Diver Database 2010-2020Patients with CTS diagnosis or recipient of carpal tunnel release surgery (identified by CPT and ICD codes)Later diagnosis of amyloidosis?YES NOAmyloid cohortStratify by gender and age at onset of CTSNon - Amyloid cohortStratify by gender and age at onset of CTSResults • Of 689,975 patients with CTS identified, 5,454 (0.76%) were later diagnosed with amyloidosis. • Most men were aged 60 years or older at the onset of CTS, and most women were between the ages of 40-59 at the onset of CTS• Comorbidity analysis demonstrated that, compared to the control cohort, the amyloidosis cohort had a five-fold higher incidence of lymphoma, a two-fold higher incidence of cancer, a two-fold higher incidence of pulmonary circulation diseases, a three-fold higher incidence of coagulopathy, and higher incidences of cardiac comorbidities, among others.

Amyloidosis and Carpal Tunnel Syndrome: A Database Study of Associated Risk Factors and Comorbidities

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1258&context=gw_research_showcase

Amyloidosis and Carpal Tunnel Syndrome: A Database Study of Associated Risk Factors and Comorbidities

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