Cricoarytenoid Arthritis in Rheumatoid Arthritis, Part 1
This is the first part in my series RA is Complicated: “Complications” of Rheumatoid Arthritis
A Rheumatoid Arthritis symptom you don’t hear much about
Did you ever have déjà vu? How about déjà vu over and over? A couple of days ago, I met yet another person with Rheumatoid Arthritis who thought she might be the only one who experienced voice loss due to RA.
Why does every RA’er I meet with vocal cord (cricoarytenoid) arthritis feel like they are the only one? You just don’t hear much about this symptom of Rheumatoid Arthritis? Why are we so quiet about this?
Are vocal cord problems due to Rheumatoid Arthritis really rare? You can find lots of websites and literature which say that vocal cord arthritis due to RA is atypical – where you can find it mentioned at all, that is. Usually, it is not mentioned.
So, how common is cricoarytenoid Rheumatoid Arthritis?
Very. Some “arthritis” materials estimate the rate of cricoarytenoid involvement to be anywhere between 17 and 75%. No wonder people are confused. At least 35% of RA’ers complain of hoarseness, a common symptom of cricoarytenoid RA.
But wait! Post mortem studies range from 45 – 88%. I have read a couple of journal articles which find autopsy evidence of laryngeal Rheumatoid Arthritis in 87% of patients. An American College of Rheumatology report found that 7 out of 8 RA patients showed histopathologic changes postmortem. They stated, “Arthritis of the cricoarytenoid joint occurs much more frequently in patients with rheumatoid disease than has generally been suspected.”
What can Rheumatoid Arthritis do to the vocal cords?
Rheumatoid Arthritis can affect the larynx in several ways. There are joints amid tiny bones (actually made of cartilage) called the cricoid and the arytenoid within the larynx. Oddly enough, the joints are called the cricoarytenoid joints.
These joints can be attacked by Rheumatoid Arthritis, just as other joints can. Sometimes, RA creates an erosive mass in the joint. Nodules may form on the vocal cord tissues which are similar to nodules on other joints. Inflammation in the larynx can lead to vocal cord fixation or vocal cord immobility.
Other types of systemic autoimmune arthritic diseases such as Ankylosing Spondylitis, Reactive arthritis, and Sjögren’s syndrome can also lead to these conditions.
What RA symptoms occur in vocal cord RA?
Here is what to watch for:
- hoarseness
- change in range of voice
- pain during speaking
- pain during swallowing
- feeling of fullness or mass in the throat
- choking sensation
- shortness of breath
- difficulty breathing
Weird but true facts about Cricoarytenoid RA symtoms
Symptoms may be acute or mild. They may be intermittent or persistent. Symptoms do not depend upon the duration or severity of the Rheumatoid Arthritis or on the age of the patient. Swelling or redness may or may not be observable during laryngoscope. It is even possible to have cricoarytenoid RA without observable symptoms.
Other types of pain
Rheumatoid arthritis in the cricoarytenoid joints is not always physically painful. However, not being able to speak or sing can be traumatic. It is also frightening to live with intermittent choking or difficulty breathing.
There is a lot more to tell you about RA in the larynx! Read Part 2 to this series on cricoarytenoid Rheumatoid Arthritis.
More links to articles referenced in this post
Intensive Care Medicine Journal
Oxford Journal of Rheumatology
Recommended reading:
- Is there a blood test for Rheumatoid Arthritis? Part 1
- Functional Measurement of Rheumatoid Arthritis
- More articles on Cricoarytenoid Arthritis in RA
- 3 Reasons to Stop Saying “Complications of Rheumatoid Arthritis”
Have you ever written down your Onset Story? Tell the world how your RA began.
I am a police dispatcher, I have from time to time felt like I had “overused” my voice especially on very busy days. I would get a sore throat and a little horse. Yesterday and the day before were particularly rough days. We had tons of wind, rain and lightning. I was in lots of pain that seems now to have become a flare. Last night I was answering phones and trying not to cough while talking, then I had a huge coughing fit and almost gagged, it scared some of my co-workers. I went home sick and spent the evening nursing a particularly painful flare and sore throat coupled with insomnia. I was up until 6am and woke up with a very sore ans swollen throat, but do not feel “sick”. This got me wondering if RA can affect the throat. Lo and behold Kelly to the answers rescue! Now I know this is the RA, I’m not going coocoo!
Thank you Kelly for posting all this wonderful information. Hoping this is a transient issue as I really need my voice to work!
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Some of those symptoms sound like an overlapping with secondary Sjogrens. I have quite a few of those but also severe dry mouth and eyes (I use a ton of biotene-like stuff and prescription floride toothpaste for my mouth and I had tear duct plugs put in last year).
Hi Kelly, I’ve experience hoarseness and cough for many years and many trips to ENTs both before and after my RA diagnosis. I’m in the midst of another round of testing after a year of inflammation in my vocal cords that is bad enough to cause frequent difficulty breathing and some very scary chocking incidents. At the moment, I have one specialist telling me I have what was formerly known as Wegener’s Granulomatosis (they’ve recently changed the name to Granulomatosis with polyangiitis or something along those lines–it’s a form of vasculitis which is inflammation of blood vessels, and can affect your respiratory system (upper and lungs), kidneys, heart, really any other part of you. It’s an equal opportunity disease like RA. Another specialist tells me my symptoms don’t fit the picture for Wegener’s and the upper respiratory inflammation and nodule in one lung could be from RA. I’m hoping my rheumatologist will look at both of their reports and resolve the issue (or maybe, if the treatment would be the same in any event, just treat it and I can stop worrying about the label but keep an eye on kidneys etc. just in case). My question for you and others on the site, is does anyone else have a dual diagnosis including vasculitis? And if so, what were the symptoms and findings that set it apart from RA? It sounds as though from what others have posted my symptoms could all be from RA but the doctors consider them to be atypical while other RA patients know otherwise. I’d love to hear from any others with similar experiences. Thanks.
I think a dual diagnosis is possible, but diagnosis is somewhat subjective and can depend upon what is affected by the vasculitis & what specialist you see. Vasculitis is also part of rheumatoid, so if you had definite rheumatoid symptoms (or positive anti-CCP), it might still be a single diagnosis. I do not have a blog post specifically about vasculitis yet, but I did write a section about it in my book & I know there is some research out there on it. Vocal cord inflammation is typical rheumatoid – I do not know if it’s common with Wegener’s or not.
Kelly, thank you for another fascinating article! I get a cough for no reason, have difficulty breathing at times, and lately get very short of breath w/any exertion.’my nephrolagist suggested I see a pulmonary specialist and a cardiologist.
I was intrigued that the article mentioned post mortem research as finding so many more prad’s w/arthritis in their trachea.’I have told my family I want to donate my body specifically for RA research when I die. They are very supportive, esp my grandson at Baylor who wants to either go to med school or do med research. However, I don’t know the protocol for doing this. Do I contact a med school, go thru my rheumy, or ask the morticians where I have already paid for a funeral service? Any suggestions, anyone?
Thanks, Linda C.
One of the most painful symptoms of my RA onset (before I was diagnosed) was difficulty and extreme pain when swallowing. I told my GP it was as if I had fishbones obstructing my throat, and that something felt structurally wrong. Thankfully it went away after a day, saving me a panicked trip to the ER. This symptom has come back whenever I have a flare (in fact it’s one of the ways I know I’m starting a bad flare). But I’ve never seen this explicitly connected (nor did my Rheumatologist make the connection) until I read your new post today. It’s so helpful knowing it’s a known aspect of RA and not just me!!
Thank you Kelly, for all you do for us. You are truly a warrior and I am so grateful!
I “just” found out I have RA about 4 days ago. I LOVE this web page. No where else on earth is there any information I can find about this, but I had it the day I saw my doctor. As correctly was onto the RA but is afraid of some type of unrelated cancer or something so I have to do an ultra sound. After suffering thru months of pains that I never had before, which started before Christmas, I had this rash show up all over my body and the voice effects at the same time and enough was enough, time to see a doctor. I was given prednisolone… which gave me decent but not total relief but that ended a week ago and all the pains and issues are slowly coming back. One thing I found helps my larynx is I notice I have rawness throughout my mouth and especially lips, if I take tiny sips of baking soda and water, swish it around mouth then swallow it, it relieves the raw-ness of my mouth and so far is keeping my throat clear. I had reached the point my voice was gurgling, I was choking on saliva all the time or when trying to eat.
Welcome Joe. I’m sorry about your recent diagnosis. And that I wasn’t here to moderate or reply to your good comments over the past few months. How is your throat doing?
Hi Kelly,
I’m glad to see this information in written form! I, too, suffer from voice loss during a flare. It’s one of my telltale signs that I’m not experiencing some other kind of ailment. The other symptom that alerts me to an oncoming flare is the skin on the sides and back of my neck become extremely sensitive to touch. Just my hair rubbing against it causes pain. When those 2 occur together, I know I need to start taking prednisone.
I came across the cricoarytenoid joint while doing research for a school paper and was floored to see my “symptom” there in print. I was glad that I finally had a name for my problem and that I wasn’t just imaging things. Thank you for being a RA Warrior.
Marie Kemper
Thank you for this post Kelly! I am a speech pathologist and also have RA. One of my first symptoms was a painful ‘click’ when I swallowed. This started happening before I was diagnosed. I thought I was going nuts because the main part of my job is to assess swallowing, so for me to suddenly develop swallowing pathology was odd, to say the least. I visited an ENT who told me “not to worry about it” (not very helpful). I asked my colleagues who are all very experienced and none of them had seen (heard) anything quite like it. I did some research and discovered a study on voice changes with RA, but nothing about swallowing. I thought that perhaps because the cricoarytenoid joint adducts the vocal cords during the swallow, that inflammation could cause it to “crack” during adduction but found no research on this anywhere. I struggled and stressed and found that turning my head to the right during swallowing was better, so I did that and tried to ignore it. And then, a month later, I received my RA diagnosis. I began my treatment on methotrexate and sulfasalazine, and a few months after that, the swallowing pain/clicking was gone. And it has not returned, three years later. I know now without a shadow of a doubt that the swallowing issue was related to RA in my cricoarytenoids and sometimes, it is nice just to know! So glad that somebody has put this into the body of literature on RA!
This is great info. My brother in law has been suffering for the last 3 months with difficulty swallowing making it difficult to eat or drink, spitting out mass, coughing, lost a lot of weight, and he ended up in the emerg. He was held in because of dehydration. Gordie has been in hospital since last monday, still doing tests, and mashing up his food. Doctors are saying he has rheumatoid arthritis. We are still unsure what his course of treatment is going to be. It has been hard on the family and what he has been going through. Hopefully, he will be given meds now to help cope with it. I am taking the info for my sister to see. Thank you.
I remember repeated bouts with hives and laryngitis. It is a strange comfort to read this article. Ooh how I wish someone would have seen out sooner.
Here I sit with no voice for the past 4 weeks…..again. I have RA and PsA and Asthma( I am on Humara and Predisone when I cant stand it anymore ). I also have a diagnosis of Vocal Cord Dysfunction. What started out this time was pain in my lower lungs when I breath and my upper back is still swollen ( go figure huh )the pain is pretty much gone but no voice and it feels like there is a hand around my throat. The exhaustion is a new one this go around. I have been here before, its just a matter of time before my Asthma flairs up which means more medicine that bothers my stomach which irritates my vocal cords and my throat which irritates my lungs which irritates my Asthma, its a viscous circle. Aint life interesting ??
Wow! Thanks so much for posting about this! I need to talk to my doctor as I have had problems with my voice ever since I started to show the typical symptoms of my RA and subsequent diagnosis. I notice my voice essentially going away completely any time I had to yell (go into a coughing fit afterwards like something was stuck in my throat) and occasionally I would have trouble breathing – just out of nowhere. Now I know what the likely culprit is!
Hi. I don’t know if I belong here, but I was told 3 1/2 years ago I have “arthritis in my throat” I was told vocal rest and speech therapy. I’m lucky, I work with therapists all the time, so I didn’t have to wait to see her. She extended the vocal rest and told me to drink LOTS if hot tea with lemon and honey. After a week if that, I was good for 18 months. Then I started losing my voice off and on, it has been mostly “off” for the last 3 weeks. I also have the feeling of fullness in my throat, but if I take prilosec every morning, that is under control. I get so tired when my voice is out. I’m a nurse at a nursing home and when my voice is out, the residents get upset with me because they think I am talking like this on purpose. Usually my throat doesn’t hurt, only occasionally. I sometimes feel SOB, but nothing serious. Sometimes I really have to concentrate to swallow, its like my body forgets how. Other than my voice, the only other thing going on is it is getting harder to get up every morning because my hips hurt so bad. I have an appointment with my primary the end of the month and 2 days later I’m going back to the ENT. I’m planning to talk to my primary about RA. Is it possible the “arthritis in my throat” is a symptom of RA? Or am I just an internet diagnoser?
Hi Fellow Warriors,
Wanted to say first please don’t ever give up. My journey through R.D. although diagnosed a mere 3 years ago has been a part of me for at least 8 years or longer. Thank you Kelly for bringing up this topic of hoarseness.My symptoms of hoarseness were over a period of time were an enemy, while at the same time a catalyst in diagnosis of severe R.D. First through a laryngascope (more than once) in ENT office and also pictures during a broncoscopy( for lungs).I’ve recently been diagnosed with nodules or growths on vocal cord flaps(both) , and within my lungs, including R.D. related lung damage that includes symptoms of shortness of breath e.t.c. I have major joint damage elsewhere that impedes my mobility in from top to bottom, no biological or DMARD has been successful for a long period of time, but they have helped me. I don’t have all the answers or know off hand many medical terms. Yes I’ve been fortunate to finally find caring and educated Dr.’s s that recognize R.D.for what it is finally. I hope I explained my experience to maybe help someone else. In my opinion I the R.D. medical professionals will realise
that loss of voice a.k.a. horseness, raspiness to no voice at all,will finally be reconized for what it is before it does it’s damage. Mine normal voice is gone for good. R.D. can steal your body and do irreparable damage. This includes, as well as my Dr. explained probable joint involvement that relates to voice as well. My case is severe I do not want to make anyone frightened that their R.D. will be this severe, it’s only to bring awareness and if it helps someone else I will be grateful. I pray the day will come soon, that our suffering can stop as we with auto-immmune diseases can find a Dr. who is caring and educated faster and stop fighting so hard to find out why malaise and fatigue has stopped normal daily function including awful pain (to say the least) & concentrate on living life to the fullest Thank you Kelly and fellow R.D. Warriors for having a voice for what is a serious disease. I only share my experience and can only express my point of view, I’m not a good writer and my hands hurt horribly today, I know many of you can relate. I pray for peace a strength to Kelly and each and every one of you. Don’t ever give up..
I just got back from my ENT. I explained to him that it feels like my voice box gets stuck on my spine. When I am getting settled to sleep and i swallow my voice box shifts and I can’t swallow with out tons of pain. I have to sit fully up and massage my throat back into place. It is very scary when it takes awhile. My dr said he has not ever seen this. He said that I have arthritis behind my voice box and that instead of the normal movement against soft tissue or cartilage mine is bone on bone and gets caught. I googled arthritis behind voice box and this page came up. Does anyone else experience the actual shifting of the larynx/voice box making it hard and painful to swallow?
Hi, yes I have experienced this and shared the info with my RA doc. Even had to have a lump check in the throat that was due to the RA to make sure it was not cancer since my Dad died of throat cancer. They wanted to be sure it was the RA. When I’m in a flair I can’t swallow even my drinks, let alone food I have to cut it up and have water close by so I don’t choke. I quit singing and avoid places where I have to talk to much.
My mom, who suffered from RD, complained that she could no longer sing…and later she could only talk for short periods of time–with hoarseness–before her voice failed completely. She blamed her asthma meds…Now I know the true story…and my own journey is taking me in the same direction. I’ve sung all over the country…and now cannot croak out a note. My speaking voice is often hoarse and I have difficulty swallowing. Thank you for this article.
I have had hoarseness often through the years and then 5 years ago I was diagnosed with RA. I have a lot of trouble swallowing a lot my thyroid dr said it is because of acid reflux which I don’t have this article was so helpful