Background: Carpal tunnel syndrome (CTS) is a common neurological disorder, particularly in individuals with rheumatoid arthritis (RA). Laser therapy combined with strengthening exercises has been proposed as an effective treatment strategy to alleviate symptoms and improve function in CTS patients with RA. The aim of study was to evaluate the efficacy of laser therapy combined with strengthening exercises in comparison to strengthening exercises alone in reducing pain, improving functional status, alleviating symptoms, improving grip strength and enhancing nerve conduction parameters in CTS patients with RA. Methods: A total of 37 participants were enrolled in study and 30 subjects were successfully completed, subjects were randomly assigned to the experimental group (EG; n=15) receiving laser therapy with strengthening exercises, or the control group (CG; n=15) receiving strengthening exercises alone. Outcome measures included pain intensity (NPRS), symptom severity (BCTQ-SSS), functional status (BCTQ-FSS), disease activity (DAS28), grip strength (Jamar dynamometer), and nerve conduction parameters (SCV, MCV, DML). Assessments were performed at baseline, 2 weeks, and 6 weeks. Results: Within-group analysis showed significant improvements in pain intensity (EG: 64.94%, CG: 27.58%), symptom severity (EG: 45.36%, CG: 14.16%), functional status (EG: 43.66%, CG: 12.57%), and disease activity (EG: 27.09%, CG: 8.46%) in both groups. However, between-group analysis demonstrated statistically significant improvements favoring the experimental group in pain intensity (p=0.026), symptom severity (p=0.001), functional status (p=0.018), disease activity (p=0.017), and sensory conduction velocity (p=0.048) at 6 weeks. No significant between-group differences were found in grip strength (p=0.179), motor conduction velocity (p=0.064) and distal motor latency (p=0.103). Conclusion: The findings suggest that laser therapy combined with strengthening exercises is more effective than strengthening exercises alone in reducing pain, improving functional status, reducing disease activity and enhancing sensory nerve conduction in CTS patients with RA. This highlights the potential of laser therapy as an adjunctive treatment in managing CTS symptoms in RA patients.