The Cricoarytenoid Joint and Rheumatoid Disease

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Speechless… the cricoarytenoid joint is commonly affected in Rheumatoid Disease

Recently a small study from Brazil raised the topic of cricoarytenoid arthritis (CA), a little-recognized aspect of Rheumatoid Disease. In 2009, RAW first discussed CA with patients who expressed amazement that their vocal cord / larynx problems were related to their Rheumatoid Disease. There are a couple of hundred comments on CA on RAW, although I seldom mention it.

Cricoarytenoid arthritis is a broad term referring to several ways that Rheumatoid Arthritis / Disease can affect the larynx, or cricoarytenoid joints. See list of cricoarytenoid symptoms below. Unfortunately, CA has frequently been supposed to be rare or inconsequential, and symptoms are often dismissed.

“He looked at me like I was an idiot and said ‘But there are no joints in the voice box.’”[1]

The role of cricoarytenoid arthritis in Rheumatoid Disease

larynx in public domainThe Brazilian study sought to investigate the inadequacy and inconsistency of research on how Rheumatoid Disease (RD) affects the cricoarytenoid joints.[2] I’m always grateful for doctors like this who show curiosity to learn how RD actually affects people. Let’s have a look.

They said –

  • “Rheumatoid arthritis (RA) is a chronic, autoimmune disease, of unknown cause, which affects mainly women between 30 and 50 years of age.”
  • “Knowledge on the laryngeal involvement in RA patients is longstanding: the changes were described by Mackenzie, in 1880, by means of studies in cadavers…”

They found –

  • 80.9% of Rheumatoid patients reported at least one CA symptom
  • The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA.
  • Posterior laryngitis was the most common diagnosis (44.7%)
  • Patients with a higher DAS score did not have significantly more laryngeal involvement, so…

They concluded –

  • “This study showed that laryngeal symptoms and laryngeal alterations are frequent in RA patients”
  • CA can compromise an individual’s quality of life
  • Dysphonia in RA individuals is more prevalent than in the general population (less than 1%), and less prevalent than in those with laryngeal diseases
  • “There was no significant relationship between laryngeal disorders and disease activity” (i.e. arthritis symptoms as measured with DAS)

Don’t miss 2 significant details

1) “No relationship between laryngeal disorders and disease activity” is unfortunate wording that results from measuring a systemic disease by counting swollen fingers. The critical point here is that extra-articular disease (CA) is not shown to correlate with joint disease activity (arthritis). This underscores the importance of improving measures of disease activity in order to capture a more complete picture of the health of patients.

2) “Could medications be to blame?” the investigators wonder. It is doubtful since many people experience CA before they are ever treated for RD. Furthermore, CA was documented long before modern treatments existed.

Possible symptoms of cricoarytenoid arthritis

  • Hoarseness / laryngitis
  • Painful swallowing (odynophagia)
  • Feeling of a foreign object / lump in the throat (globus pharyngeus)
  • Sore throat
  • Cough
  • Difficulty breathing (dyspnea)
  • Change in sound or tone of voice (dysphonia)
  • Loss of voice (aphonia)
  • Pain during speaking
  • Pain during swallowing (dysphagia)
  • Choking sensation
  • Stridor (high pitched sound caused by difficulty breathing)

Concerns of cricoarytenoid arthritis in PRD

  • Voice changes or difficulty singing may affect employment.
  • CA can be painful or uncomfortable; “Both dysphonia and RA may compromise an individual’s quality of life.”[2]
  • Sometimes CA requires injections or surgical intervention such as tracheostomy[2]; PRD in our community have given testimony of both.
  • Anesthesia complications: CA may make intubation difficult or lead to postoperative exacerbation.[3]
  • Rarely, CA can be life threatening. Patients need to be honest about symptoms with doctors they can trust.

Recommended reading

MORE

FOOTNOTES

1 Patient comment. 2013 Apr 17 [cited 2014 Jan 28]. Available from: http://rawarrior.com/cricoarytenoid-arthritis-in-rheumatoid-arthritis-part-1/?show=comments#comment-203637
2 BeirithI SC, ; IkinoII CMY, Pereira IA. Laryngeal involvement in rheumatoid arthritis. Braz J Otorhinolaryngol [Internet]. 2013 Mar/Apr  Laryngeal Manifestations of Rheumatoid ArthritisLaryngeal Manifestations of Rheumatoid ArthritisLaryngeal Manifestations of Rheumatoid ArthritisLaryngeal Manifestations of Rheumatoid Arthritis[cited 2014 Jan 28];79(2). Available from: http://dx.doi.org/10.5935/18088694.20130040
3 Fombon FN, Thompson JP. Anaesthesia for the adult patient with rheumatoid arthritis. Contin Educ Anaesth Crit Care Pain [Internet]. 2006 [cited 2014 Jan 28];6(6):235-239. Available from: http://ceaccp.oxfordjournals.org/content/6/6/235.full

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, January 29th, 2014 at 4:44 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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