Vocal cord lesions in representative autoimmune diseases

The aim of this study was to describe the clinical features of vocal cord lesions in patients with representative autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

A total of 31 SLE/RA patients (14 SLE and 17 RA) complicated with vocal cord lesions (SLE/RA-VC group) who had been admitted to Peking Union Medical College Hospital were retrieved from the electronic registration system. Ninety-three age and sex-matched SLE/RA patients (42 SLE and 51 RA) without vocal cord lesions (SLE/RA-nVC group) admitted during the same period were chosen randomly as controls. Medical files were reviewed and clinical data collected for comparisons.

Vocal cord paralysis (n = 12, 38.7%) and vocal cord mass (n = 14, 45.2%) were the most common types of vocal cord lesions in this cohort. Unilateral lesions were more common than bilateral lesions (67.8% vs 32.3%) and the two sides were affected equally. Two cases of vocal cord bamboo node lesion were observed in SLE-VC group even as an initial manifestation and SLE-VC group had a slightly higher disease activity index (SLEDAI-2K) than their control counterparts (18.56 ± 8.23 vs 13.63 ± 5.89, p = 0.041). The RA-VC group had less pulmonary interstitial disease (29.4% vs 63%, p = 0.017) and lower CRP levels (p = 0.006) than their controls. As for the treatment, 71% of SLE/RA-VC patients had received glucocorticoids and immunosuppressants and 30% had undergone surgery. 45.2% of SLE/RA-VC patients got improvement at the time of discharge.

The association of vocal cord lesions with disease activity can be observed in SLE patients but not in RA patients. Vocal cord lesions in SLE/RA patients should be considered as a part of the systemic involvement and should be treated accordingly. Key Points • Vocal cord paralysis and vocal cord mass were the main types of vocal cord lesions in patients with SLE/RA. • Vocal cord lesions in SLE patients may associate with disease activity and vocal cord bamboo node lesions could be an initial manifestation. • Glucocorticoid and immunosuppressants could be effective for vocal cord lesions in SLE/RA patients.