Rheumatoid arthritis (RA) is an inflammatory disease that causes the body’s immune system to go into overdrive, attacking the synovial lining of the joints. The result is inflammation and swelling of the joints and ultimately damage to the tissue and cartilage.

An uncommon, but well known complication of RA is cricoarytenoid arthritis (CA). Cricoarytenoid arthritis is essentially rheumatoid arthritis in the cricoarytenoid joint (CJ) between the cricoid and arytenoid cartilages in the back wall of the larynx. The CJ changes the tone of the voice by rotating as the vocal chords vibrate.

Involvement of the CJ in rheumatoid arthritis patients has been estimated as high as 70%, although those who actually experience symptoms represent a very small percentage. The symptoms include a sensation of something in the throat which can be aggravated when speaking or swallowing. Symptoms also include hoarseness or pain when speaking or coughing, and shortness of breath (dyspnoea).

Cricoarytenoid arthritis is most common in patients with rheumatic disease. There are other conditions, scleroderma, however, that have been shown to be the source of CA, including gout, lupus, upper respiratory infections, trauma, vocal cord tumors and Tietze’s syndrome

Diagnosing CA can be difficult. The most common diagnostic procedure is a fiber optic laryngoscopy. Neck radiography and computed tomography (CT) scans are also methods used to diagnose CA.

Treatments include resting the voice, direct heat, steroids and anti-inflammatory drugs. Steroids may be injected locally or in the form of a topical cream. If the breathing is affected it may be necessary to perform intubation or a tracheotomy, or tracheostomy.

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