Rheumatoid arthritis of the cricoarytenoid joint: A clinicopathologic study

Abstract

Arthritis of the cricoarytenoid joint OCcurs much more frequently in patients with rheumatoid disease than has generally been suspected. Seventeen of 64 randomly selected patients with rheumatoid arthritis had one or more symptoms considered to be characteristic of cricoarytenoid arthritis. At postmortem examination, histopathologic changes typical of rheumatoid arthritis were seen in the cricoarytenoid joints in seven of eight patients with rheumatoid arthritis. The abnormal findings on indirect laryngoscopy, typical of rheumatoid arthritis of the cricoarytenoid joints, are reported and treatment is discussed. HE CRICOARYTENOID JOINT is more frequently involved in rheuma-T toid arthritis than is generally suspected. The importance of this joint in phonation and respiration accounts for reports predominately in the otolaryngologic literature dealing with various types of cricoarytenoid arthritis.2-'b The following clinicopathologic study was undertaken to determine the frequency, severity, and types of changes in this joint found in patients with rheumatoid arthritis.The anatomic features of the cricoarytenoid joint help explain the signs and symptoms encountered. The cricoarytenoid joint is diarthrodia1,l with a ligamentous capsule lined by synovial membrane. Muscles act on the joint to adduct and abduct the vocal cords. Two types of movement occur during normal phonation and respiration: 1 ) rotation of the arytenoid on a vertical axis, which allows the vocal process to move laterally and medially, thereby increasing and decreasing the glottic space; and 2 ) a gliding movement by which the arytenoid cartilages approach and recede from each other. Gliding and rotation are intimately integrated-medial gliding with medial rotation and lateral gliding with lateral rotation. METHOD OF STUDYThe clinical features of cricoarytenoid arthritis were studied in two groups of patients with rheumatoid arthritis attending the rheumatic diseases clinic

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.…”

Repeated postoperative laryngeal obstruction due to bilateral cricoarytenoid joint involvement in rheumatoid arthritis

“…1,5 Although this involvement is a well-known concept in otolaryngology, obstruction of the airways is a rarely seen complication of rheumatoid arthritis. 6,7 An interesting feature of the case reported here is the repeated postoperative laryngeal obstruction that occurred just after extubation and 3 weeks postoperatively when the physiotherapy program had progressed to ambulation.…”

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

“…[5][6][7] Involvement of the cricoarytenoid joint has been reported in 26%-86% of patients with rheumatoid arthritis and can be asymptomatic. 8,9 Furthermore, the severe discomfort characteristic of rheumatoid disease can lead the clinician to overlook cricoarytenoid involvement. 5,10,11 Although first reported in 1880, greater attention has been paid to cricoarytenoid arthritis following Montgomery's 1955 publication on rheumatoid arthritis of the larynx.…”

“…The joint controls abduction and adduction of the vocal cords thereby facilitating respiration, as well as protecting the airway and permitting phonation. 9,14 Any synovial articulation can potentially be affected by rheumatoid arthritis. Increased cellularity of the synovium occurs leading to synovial inflammation.…”

“…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. Systemic, topical or locally injected steroids are beneficial, although the value of high-dose steroids is controversial.…”