[Fixation of the crico-arythenoid joints in rheumatoid arthritis--preliminary report]

Rheumatoid arthritis (RA) is a systemic disease of connective tissue which affects joints lined with synovial membrane. Laryngeal joints also have such a structure. Among all reasons leading to their inflammation rheumatoid arthritis is mentioned on the first place. In larynx RA mostly affects cricoarythenoid joints (CA). RA of the CA joints is found in 27% to 78% suffering from RA. In the acute phase of the disease patients complain of burning and foreign body sensation in the throat, hoarseness, pain on speaking, voice fatigability, problems with swallowing. Chronic RA of the CA joints can lead to their fixation and dyspnoea, requiring emergency tracheotomy. According to the literature, this state occurs in 10% to 25% patients suffering from RA. A case of 75 years old woman is presented, who was admitted to our Clinic with severe inspiratory dyspnoea requiring tracheotomy. She was suffering from RA for 26 years. She complained of effort dyspnoea, problems with swallowing and tightness sensation in the throat for 4 years. Patient complained also about cervical spine pain, upper right extremity and knee joint periodic oedema. The patient was suffering from so severe lower extremities pain and rheumatoid changes in knee joints that she had to walk on crutches. Little hands' joints were deformed with significant ulnarisation. Videolaryngostroboscopic examination showed no movement in CA joints, paramedian position of the vocal folds and narrowing of the glottic rim to 1.5 mm. Phonatory mobility of the vocal folds was preserved. Electromiographic examination of the internal laryngeal muscles made a) during phonation--showed bilateral normal bioelectrical record from thyroarythenoid muscles, b) at rest--there was no denervation activity. In computerized tomography study no degenerative changes in CA joints were found. On the basis of clinical view and examinations results, there was considered that fixation in CA joints was due to degenerative changes, which were the result of their rheumatoid inflammation. It was emphasized that this subject has been mentioned only several times in laryngological and phoniatric handbooks and in few articles.