Cricoarytenoid Arthritis: Overview and More

A sore throat from rheumatoid arthritis

Updated on August 03, 2021

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The cricoarytenoids are a pair of small joints in the back wall of the larynx (voice box) that help open, close, and tighten the vocal cords during speech and breathing. These joints take their name from structures they lie between: the cricoid and arytenoid cartilages.

Rheumatoid arthritis (RA) and other rheumatic diseases can impact these joints and, because they sit near the windpipe, cause hoarseness and difficulty breathing. This condition is known as cricoarytenoid arthritis.

Cricoarytenoid arthritis is most common in people with RA, but it can also occur in other autoimmune diseases, including:

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

Post-mortem studies have revealed that 90% of people with RA had involvement of the cricoarytenoid joint as well as the nearby cricothyroid joint, temporomandibular joint (jaw), and associated structures in the larynx.

Nurse talking to patient in doctor's office — Ariel Skelley / Getty Images

Cricoarytenoid Arthritis Symptoms

Not everyone who has abnormalities involving the cricoarytenoid joint experiences symptoms - and the reasons behind this are not well understood. In some cases, symptoms begin even before there are observable changes in the joint.

Symptoms of cricoarytenoid arthritis include:

Hoarseness
Pain when swallowing (odynophagia)
Feeling like something is stuck in your throat
Pain when talking or coughing
Shortness of breath (dyspnea)
Harsh or grating sound while breathing (stridor)

If you have these symptoms, don't pass them off as being something minor. Sometimes the hoarseness and breathing problems are the only signs that someone has RA or another rheumatic disease.

Stridor Is an Emergency

Stridor is the sudden onset of an abnormal, high-pitched sound when you breathe that's caused by a blockage in the larynx or throat. It should always be treated right away as a medical emergency to prevent the airway from becoming completely blocked.

Causes

RA affects joints by causing inflammation in the synovium, which is the lining of the joint. This spreads to the surfaces of the bones and causes fibrosis, which can eventually lead to rigidity and immobility that's known as ankylosis. When this happens in the cricoarytenoid joint, it becomes less able to move the vocal cords or assist in breathing.

When cricoarytenoid arthritis is part of RA and other autoimmune diseases, symptoms are caused by the immune system attacking the joint or associated structures as if they were a dangerous pathogen instead of a normal part of the body. The causes of autoimmunity are unknown.

Why Rheumatoid Arthritis Develops

Diagnosis

When cricoarytenoid arthritis occurs as part of a previously diagnosed disease, healthcare providers may use various imaging techniques to look at the larynx, including:

Laryngoscopy: A laryngoscope (a long, thin instrument including a light and small video camera) is inserted through your mouth or nose to examine your larynx and other structures in your throat; alternatively, a light is shined at the back of your throat while the healthcare provider uses a mirror to get a look.
Microlaryngoscopy: This surgical procedure uses a laryngoscope with a microscope to examine the larynx, evaluate airway obstruction, and possibly to remove some tissue for biopsy.
Electromyography (EMG): This test uses electrodes to stimulate nerves and measure muscle response; it can help healthcare providers diagnose neuromuscular problems.
Computed tomography (CT) scan: Multiple X-ray images are taken and combined into a 3D image of the larynx and other structures in the throat.

A physical exam will likely include palpating (pushing on and manipulating) the cricoarytenoid joint to see if it's stiff or rigid.

If laryngeal symptoms are the first signs of disease, your healthcare provider may begin by checking for specific autoimmune diseases based on your symptoms and history. Blood tests may look for:

Inflammatory markers, including erythrocyte sedimentation rate (ESR or sed rate), C-reactive protein (CRP) test, and plasma velocity (PV)
Autoantibodies (antibodies that attack healthy tissues)
Rheumatoid factor (RF), which can indicate RA
Complete blood count (CBC)
Comprehensive metabolic panel (CMP)

How Rheumatoid Arthritis Is Diagnosed

Treatment

Because cricoarytenoid arthritis is a consequence of other diseases, treating the underlying disease may help ease symptoms. This could include the use of immunosuppressive and anti-inflammatory medications.

Clinical Guidelines for Treating RA

Clinical guidelines for RA treatment, published in 2021 by the American College of Rheumatology, doubled down on previous guidance emphasizing the use of methotrexate as the primary disease-modifying anti-rheumatic drug (DMARD) treatment option. Another medication can be added if methotrexate does not work well enough or for people dealing with another health condition at the same time. Talk with your healthcare provider about the best options for managing cricoarytenoid arthritis associated with RA.

Specific treatment for mild symptoms of cricoarytenoid arthritis usually begins with high-dose systemic corticosteroids. If that doesn't work, an injection of corticosteroids into the cricoarytenoid joint may be required.

In certain situations in which the arthritis is interfering with breathing or speech and not responding to other treatments, surgery may be an option. Procedures can include:

Tracheostomy: An emergency surgery that may be needed when breathing becomes seriously blocked, this involves creating a hole in your windpipe and inserting a tube to serve as an alternative airway
Arytenoidectomy: Generally performed to maintain an open airway after tracheostomy, this procedure involves removal of laryngeal cartilage to which the vocal cords are attached.
Arytenoidopexy: The cartilage at the back of the larynx is fixed in place surgically to restore loss of voice due to total vocal cord paralysis.

Precautions for Surgery

If you have cricoarytenoid joints and need to be intubated for surgery, precautions need to be taken to prevent the procedure from causing further damage.

How RA Is Treated

Frequently Asked Questions

What are the cricoarytenoid joints?

The cricoarytenoids are two small joints in the back of the larynx between the cricoid and arytenoid cartilages. The joints help to open, close, and tighten the vocal cords during speech and breathing.

Can arthritis affect the throat?

Yes, arthritis can affect the cricoarytenoid joints in the throat. Symptoms include hoarseness, painful swallowing, feeling like something is stuck in your throat, shortness of breath, and loud breathing.

What do the posterior cricoarytenoid muscles do?

The posterior cricoarytenoid muscles control the vocal cords.

A Word From Verywell

If you have RA or another autoimmune disease, be sure to mention it when you go to the healthcare provider with symptoms that could be due to cricoarytenoid arthritis. With proper diagnosis and treatment, you should be able to find some relief from these symptoms.