Laryngeal involvement in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane, which causes joint damage and bone destruction. Extra-articular manifestations are numerous, involving multiple organ systems. Rheumatoid nodules are common extra-articular findings occurring in 20% RA patients. They develop most commonly in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and others. Furthermore, RA affects the ear, nose, and throat, causing various otorhinolaryngological symptoms. In this report we describe two patients with RA and laryngeal involvement, mostly rheumatoid nodule formation, with a review of the literature.

Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Management?

“…These manifestations can be either secondary to vocal cord lesions (rheumatoid nodules), or involvement of the crico-arytenoid joint, or, more rarely, secondary to amyloidosis or Sjogren's syndrome (as also mentioned later in the text) [3]. There are two stages of laryngeal involvement in RA [6].…”

“…The prevalence of Sjögren's syndrome ranges between 0.5 and 3% [1], whereas RA occurs in 0.5 to 1% of the population [2]. The prevalence of laryngeal involvement in RA ranges from 13 to 75% in different series and between 45 and 88% in postmortem studies [3][4][5][6][7][8][9][10][11][12][13][14]. Laryngeal involvement is uncommon in Sjögren's syndrome.…”

“…5) [46,47]. MRI scans can also be used [3]. Chest HRCTs can also be suggestive of obliterating bronchiolitis, or other RA-associated COPD, and should be performed in combination with the appropriate lung function tests in patients with shortness of breath.…”

“…In the absence of any suspicious pathology, EMG and palpation of the arytenoids under general anesthesia can assist in the differential diagnosis. Normal EMG findings of the thyroarytenoid muscle, and fixed cricoarytenoid joint on direct laryngoscopy, are suggestive of vocal cord palsy secondary to cricoarytenoid joint arthritis or cricoarytenoid joint subluxation [3,48].…”

“…Early identification of the problem and administration of high dose intravenous steroids, or injection of topical steroids in the cricoarytenoid joint, can treat the inflammatory process [50]. Treatment with steroids shows good response, with patients being free of symptoms and having normal larynx on flexible nasoendoscopy even two years after an acute episode [3,20]. Symptomatic rheumatoid nodules of the vocal folds can be removed with micro-laryngoscopy.…”