A 45-year-old male with rheumatoid arthritis presents with numbness and tingling in his right hand, particularly in the thumb, index, and middle fingers. The symptoms are worse at night and often wake him from sleep. What could be the cause, and what are the next steps?
This patient's symptoms are suggestive of carpal tunnel syndrome, which is common in patients with rheumatoid arthritis due to persistent inflammation and swelling in the wrist. The next steps should include confirming the diagnosis with nerve conduction studies. Initial treatment typically involves wrist splinting and nonsteroidal anti-inflammatory drugs (NSAIDs). In severe or refractory cases, local corticosteroid injection or surgical decompression may be necessary.