Rheumatoid Arthritis and the Cricoarytenoid Joint

The cricoarytenoid joints near your windpipe can be affected if you have rheumatoid arthritis, causing hoarseness and difficulty breathing. The cricoarytenoid joints are between the cricoid and paired arytenoid cartilages in the back wall of the larynx. The cricoarytenoid joints help open, close, and tighten the vocal cords during speech and breathing.

The cricoarytenoid joint is a diarthrodial joint, meaning that the joint is surrounded by a fibrous joint capsule and has synovial fluid lubricating the surfaces of the bones. Rheumatoid arthritis affects the joint by causing inflammation of the synovial lining. This spreads to the surfaces of the bones, causing fibrosis. That may eventually cause rigidity and adhesion, known as ankylosis. This process leads to reduced mobility and function in the joint. In the case of the cricoarytenoid joint, it is then less able to move the vocal cords or assist in breathing.

Abnormalities of the cricoarytenoid joint detected by imaging don't match up well with the degree of symptoms the patient has. The changes to the joint can happen before or after a person has any symptoms.

Cricoarytenoid arthritis is most common in rheumatoid arthritis patients, but it can also occur in other conditions, including scleroderma, gout, lupus, upper respiratory infections, vocal cord tumors, and Tietze's syndrome.

Rheumatoid arthritis was once thought to rarely affect the laryngeal joints, even though historical descriptions of the condition report hoarseness as a symptom. However, further research in the 1960s found about one in three people with rheumatoid arthritis had cricoarytenoid arthritis.

Involvement of the cricoarytenoid joint, cricothyroid joint, temporomandibular joint, and associated structures in the larynx is found in 90 percent of people with rheumatoid arthritis upon post-mortem examination. Why some people have more involvement and more symptoms and others don't is not known.

Symptoms include the following:

• Hoarseness
• Pain when swallowing (odynophagia)
• Sensation of having something stuck in your throat
• Pain when talking or coughing
• Shortness of breath (dyspnea)

If you have these symptoms, don't pass them off as being something minor. If your symptoms persist, consult your doctor. Sometimes the hoarseness and breathing effects are the only signs that a person has rheumatoid arthritis.

Mild symptoms are typically treated with high-dose systemic corticosteroids. If that doesn't work, an injection of corticosteroids into the cricoarytenoid joint may be required. If none of the medications work, surgery may be performed. Procedures can include a tracheostomy, arytenoidectomy (removal of cartilage at the back of the larynx to which the vocal cords are attached), or arytenoidopexy (surgical fixation of the cartilage at the back of the larynx).

Having arthritis in the cricoarytenoid joints is a concern if a patient needs to be intubated and precautions need to be taken to not cause further damage.