Cricoarytenoiditis: CT assessment in rheumatoid arthritis.

Abstract

The cricoarytenoid (CA) joint is a true diarthrodial joint that can be affected by rheumatoid disease. Its strategic location in the airway anatomy makes its evaluation of clinical importance. Direct fiberoptic laryngoscopy (DFL) and high-resolution computerized tomography (HRCT) were used to assess the larynx in 32 rheumatoid patients. Abnormalities were seen in 75% of patients at endoscopic examination. HRCT studies showed abnormalities in 72%. Erosion-luxation of the CA joint and surrounding soft-tissue swelling can be demonstrated on HRCT scans. A radiologic grading of the rheumatoid larynx is proposed, stressing that accurate evaluation of the larynx should be part of the diagnostic evaluation of every rheumatoid arthritic patient, given the high frequency of occurrence of rheumatoid laryngitis.

Cricothyroid Joint Abnormalities in Patients With Rheumatoid Arthritis

“…11 Since then, there have been several studies that have demonstrated a high prevalence of laryngeal abnormalities in patients with RA, with the incidence being higher in females compared with males. [1][2][3][4][5][6][7][8][9][10][11][12] Most reports on laryngeal involvement in RA patients have focused on the CAJ because of the prevailing increase in incidence and the subsequent serious clinical implications. Acute laryngeal involvement can cause swelling of the vocal folds with airway obstruction, and chronic involvement can impair vocal fold mobility with resultant fixation and narrowing of the glottis.…”

“…On CT scanning, the prevalence of CAJ abnormalities vary between 54% and 72%. 7 The most commonly reported findings include cricoarytenoid prominence (46.6%), density and volume changes in the CAJ (46.6%), sublaxation (39.9%), decrease in the CAJ space (13.3%), narrowing in the piriform sinuses (33.3%), and irregularities in the contour of the CA joint (20%). Erosion and ankylosis seem to be less common.…”

“…6 The yield of imaging technique in the detection of CAJ involvement can go from 25% to 72% depending on the sensitivity of the technique used, with 58% of the patients being asymptomatic. 7 In a study by Jurik and Pedersen et al, low-voltage radiography revealed osseous destruction of the CAJ in up to 45% of their 22 patients. 8 High-resolution computed tomography (HRCT) scan seems to be more useful for early detection of CAJ arthritis, where the presence of cricoid cartilage erosion is often mistaken for an aggressive carcinoma of the larynx.…”

L’arthrite crico-aryténoïdienne: une cause d’obstruction des voies respiratoires supérieures dans l’arthrite rhumatoïde

“…18 Radiologic evaluation using low-voltage neck radiography and computed tomography can also be diagnostic. 1,19 Treatment of rheumatoid cricoarytenoid arthritis involves management of the systemic disease. 9 Acute stage therapy includes voice rest, local heat, antiinflammatory medication and steroids.…”

“…Any synovial surface in the body can be affected and females are in the majority. [1][2][3] Comprehensive assessment of the potential hazards facilitates careful anesthetic management. [2][3][4] We report a case of acute upper airway obstruction due to cricoarytenoid arthritis, a well-known but rare complication of rheumatoid arthritis.…”