Background/Purpose:

Laryngeal involvement is not uncommon in connective tissue diseases including Rheumatoid Arthritis (RA). Its prevalence has been estimated between 5% and 70% of patients and, in post mortem series, between 45% and 88% of patients. The crico-arytenoid joint is the most commonly affected site. Dysphonia, cough, dryness symptoms, foreign body sensation and odynophagia are among the symptoms of laryngeal involvement although, quite often, it is asymptomatic.

With this study, the authors aimed to evaluate laryngeal involvement in RA patients and healthy sex and age matched controls and evaluate results within the RA patients group according to disease activity and duration of disease.

Methods:

This is a cross-sectional study that evaluated laryngeal involvement in RA. Patients were accessed using videolaryngostroboscopy (VLS) and objective changes were recorded using the reflux finding score (RFS). The Reflux Symptom Index (RSI), was used to evaluate laryngopharyngeal symptoms and Vocal cord impairment was accessed using the Voice Handicap Index-10 (VHI-10). Statistical analysis was performed using non-parametric tests, given the small sample size and non-normal distribution of the variables.

Results:

We enrolled 48 RA patients, with mean disease duration of 13 years, and 30 healthy sex and age matched controls. Two males were active smokers in each group and, in RA group, 4 males and 3 females were previous smokers. 77.8% of the patients were being treated with Metotrexate, 6.25% were receiving concurrent medication with prednisolone above 7.5 mg daily, 14.58% were also medicated with AINE’s on demand and 66.67% used proton pump inhibitors, mostly as a preventive measure.

Compared with controls, RA patients presented higher median values in the RFS (p< 0.0001) and RSI (p=0.0002) but differences in the VHI-10 were non-significant.

Within the RA group, there were no significant differences in the RFS, RSI nor VHI-10 when comparing patients with DAS 28 3V above vs below 2.6 at the time of evaluation. However, we found significant differences regarding the RSI when evaluating patients according to duration of disease, with patients with longer disease duration having higher scores (0-5 vs 6-10 years p=0.03; 0-5 vs 11-15 years p=0.047; 0-5 vs >15 years p=0.015).

Even though no differences were found regarding the RFS, patients within the > 15 years of disease duration, presented a higher median score (median scores for: < 5 years = 2.5, 6-10 years = 3, 11-15 years = 4, > 15 years= 7).

Conclusion:

We found significant differences between RA patients and healthy controls regarding self-perceived laryngeal symptomatology (RSI) and findings on VLS (RFS), with patients scoring higher.

RA patients with longer disease duration had more symptoms and more alterations on laryngeal examination but there were no significant differences according to disease activity.

Current evidence, as identified in the present study, suggests that laryngeal manifestations in RA patients may be underdiagnosed and a multidisciplinary team approach is necessary to improve the overall patient management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ra-voice-evaluating-laryngeal-involvement-in-rheumatoid-arthritis-patients/