Cricoarytenoid Arthritis in Rheumatoid Arthritis Patients

Incidence

Arthritis of the cricoarytenoid joints is not as rare as is commonly believed. Many sources still consider cricoarytenoid arthritis (CA) to be an atypical symptom of rheumatoid arthritis (RA) in spite of evidence to the contrary. However, at least 35% of RA patients complain of hoarseness which is the most common symptom of cricoarytenoid involvement. Historical narratives about the disease we now call “rheumatoid arthritis” also reference hoarse voice.

There is good reason for confusion about the incidence of CA in RA: Various sources estimate the rate of CA in RA to be between 17% and 75%. Post mortem studies state that evidence of laryngeal arthritis is present in 45% to 88% of RA patients. An American College of Rheumatology report found that seven out of eight RA patients showed histopathologic changes post mortem. They stated, “Arthritis of the cricoarytenoid joint occurs much more frequently in patients with rheumatoid disease than has generally been suspected.” However, a fewer number of them had been identified as symptomatic of laryngeal RA.

Symptoms

Cricoarytenoid arthritis leads to vocal cord immobility which is most commonly exhibited as hoarseness of voice. Symptoms may be acute or mild, and intermittent as a “flare” or more permanent. The voice may be altered only slightly or the patient may experience a complete loss of voice, being barely able to whisper.

Other symptoms include a sense of fullness or mass in the throat, pain during speaking, shortness of breath, dysphagia, pain during swallowing, dyspnoea, difficulty breathing, and choking sensation. Symptoms are not directly related to disease duration, disease severity, or age of patient. CA can be mistaken for asthma if breathing becomes stridorous.

Significance

Diagnosis depends mostly upon the description of symptoms by the patient. A laryngoscope does not always reveal visible swelling or redness. RA patients with diagnosed CA involvement do not usually require additional treatment. Treatment of the disease is treatment of the CA, unless the CA is acute. This is comparable to any other joint in an RA patient.

However, undiagnosed CA can be perilous. Undiagnosed CA is particularly dangerous during any surgery, since intubation can trigger vocal cord immobility. Vocal cord immobility caused by CA can lead to death in severe or untreated cases. In cases of severe CA, prednisone may be applied directly or surgery may even be required as a life saving measure.

Kelly Young is the author of the Rheumatoid Arthritis Warrior website and a 3 part series on CA in RA: Cricoarytenoid Arthritis in R A (Rheumatoid Arthritis), part 1.