AB0349 Oto-rhino-laryngological manifestations of rheumatoid arthritis

Abstract

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disorder that can damage a wide variety of body systems. Ear, nose and throat (ENT) involvement is frequent but not often reported. The purposes of our work are to determine the prevalence of ENT involvement during RA and to evaluate its correlation with RA disease activity.ObjectivesThe purposes of our work are to determine the prevalence of ENT involvement during RA and to evaluate its correlation with RA disease activity.MethodsThis is a cross-sectional study of 90 consecutive RA, followed at the Rheumatology department of Monastir Teaching Hospital in Tunisia, during 06 months (November 2016 to April 2017) and 46 matched volunteers. ENT clinical examination with tonal audiometry and thyroid tests (TSH, T4, anti-Thyroperoxidase Ab (Anti TPO Ab) and Anti-Thyroglobulin Ab (Ab anti Tg) were performed.ResultsENT involvement prevalence was 78%. The most frequent functional signs were intermittent dysphonia in 50% and dysphagia in 42% of cases. The neck examination revealed painful larynx mobilisation in 58% cases and cervical lymph nodes in 7% of cases. Indirect laryngoscopy, performed in the 67% of symptomatic patients, noted inflammatory mucosa in 38% of cases and decrease in vocal cord mobility in 8% of cases. Seventy percent patients had temporomandibular Joint (TMJ) involvement. Tonal audiometry revealed 42% of cases of deafness: 27% sensorineural deafness, 13% conductive deafness and 2% cases mixed hearing loss. The ENT manifestations significantly associated to RA compared to the witness group (p<0.01) were intermittent dysphonia, dysphagia, painful larynx mobilisation, inflammatory nasal mucosa, painful TMJ and deafness. Active disease (DAS 28>3.2)is statistically associated with deafness (p≤0.048) and TMJ involvement (p≤0.009). Logistic regression study shows that RA duration over 10 years was associated to laryngeal dyspnea (OR=4.4, p≤0.012, IC (95%) [1.377, 14.134]) and deafness (OR=3.8, p≤0.03, IC(95%) [1.142, 12.882]). In the other hand, RA moderate functional handicap is a protective factor (OR=0.123, p≤0.016, IC (95%) [0.076, 0.772]) of ENT involvement and biotherapy use was associated to thyroid involvement (OR=7.8, p≤0.017, IC(95%) [1.431, 43.175]).ConclusionsENT involvement is a very common, usually asymptomatic extra-articular manifestation during RA. It is, mainly, TMJ involvement, deafness and dysphonia. The main relevant determinants are RA disease activity and duration.References[1] Minichiello, Émeline, Luca Semerano, et Marie-Christophe Boissier. Évolution dans le temps de la polyarthrite rhumatoïde: incidence, prévalence, gravité. Revue systématique de la littérature. Revue du Rhumatisme2017janvier 1;84(1):9–16.[2] Iguelouane N, Skandour D, Rochdi Y, Nouri H, Aderdour L, et A. Raji. Les manifestations ORL dans les maladies systémiques: à propos d’une série de 200 cas. 121e Congrès2014, 11–13octobre;131(4). Paris – Palais des Congrès.Disclosure of InterestNone declared