title: Three cases of rheumatoid arthritis with laryngeal stridor.
abstract: The purpose of this is case-based review is to report a series of patients with rheumatoid arthritis who developed stridor and highlight this potentially life-threatening manifestation of the disease. We report three cases from the Rheumatology Department of University College Hospital, London and review the literature on the prevalence, clinical presentation, histopathological features and treatment of laryngeal involvement in rheumatoid arthritis. In two patients, emergency tracheostomy was necessary to maintain a patent airway. One patient improved with systemic corticosteroids without the need for surgical intervention. All patients were seropositive with anti-CCP antibodies and had long-standing erosive disease. Stridor in patients with rheumatoid arthritis is typically due to arthritis of the cricoarytenoid joints leading to fixation of the vocal cords in a midline position. Cricoarytenoid joint arthritis may be acute, chronic, or acute-on-chronic. Emergency tracheostomy may be life-saving in cases of acute stridor. Cricoarytenoid inflammation and airway compromise may respond to local or systemic corticosteroid therapy. Other causes of vocal cord paresis in rheumatoid arthritis include ischaemic neuropathy of the recurrent laryngeal and vagus nerves due to vasculitis or cervicomedullary compression due to rheumatoid involvement of the cervical spine.
authors.affiliation: Department of Rheumatology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK. jimmypeters1980@yahoo.co.uk
authors.forename: James E
authors.initials: JE
authors.lastname: Peters
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burke
authors.forename: Vanessa H
authors.initials: VH
authors.lastname: Morris
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis*; D001193:Arytenoid Cartilage / Q000473:pathology; D003413:Cricoid Cartilage / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation; D007818:Laryngeal Diseases / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D012135:Respiratory Sounds / Q000175:diagnosis*; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000473:pathology; D014826:Vocal Cord Paralysis / Q000150:complications / Q000175:diagnosis
chemical_list: D000305:Adrenal Cortex Hormones