Education And Debate

Lesson of the Week: Acute laryngeal obstruction in rheumatoid arthritis

BMJ 1996; 312 doi: (Published 03 February 1996) Cite this as: BMJ 1996;312:295
  1. D H Bossingham, rheumatologista,
  2. F G Simpson, director of thoracic medicineb
  1. a 130 Abbott Street, Cairns, Queensland 4870, Australia
  2. b Cairns Base Hospital, Esplanade, Cairns, Queensland 4870, Australia
  1. Correspondence to: Dr Bossingham.
  • Accepted 3 August 1995

Disease of the cricoarytenoid joints in rheumatoid arthritis has been recognised for many years1 and may present with hoarseness, pain in the larynx, or the sensation of a foreign body in the throat. The prevalence of involvement has been assessed at between 26% and 69% in relatively small groups of patients.2 3 No relation with age, disease duration, or disease severity has been shown. Cricoarytenoid joint involvement is best assessed by appropriate questioning and direct or indirect laryngoscopy.3 Loss of movement may then be apparent, as may local swelling or erythema.

In patients with rheumatoid arthritis who are dyspnoeic or wheezy cricoarytenoid joint disease must be excluded by laryngoscopy

Cricoarytenoid disease may present acutely or intermittently, presenting difficulties in diagnosis and treatment.4 5 6 We report a case where abnormal respiratory function tests suggested an alternative diagnosis and led to an acute presentation and near fatal outcome.

Case report

This 55 year old woman had developed seropositive, erosive rheumatoid arthritis in 1966 at the age of 26. Her disease deteriorated and required treatment with non-steroidal anti-inflammatory drugs and then, by 1980, with prednisolone. …

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