title: Voice symptoms in patients with autoimmune disease: a cross-sectional epidemiological study.
abstract: OBJECTIVE
  To assess the prevalence and severity of voice symptoms in individuals with a diagnosis of autoimmune disease.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Study participants were recruited from a rheumatology tertiary referral clinic at Norfolk and Norwich University Hospital.
  
  
  METHODS
  A cross-sectional questionnaire analyzing 109 patients with autoimmune disease (rheumatoid arthritis, seronegative spondyloarthritis, connective tissue disease) and a control group of 41 patients with non-autoimmune disease (osteoarthritis/osteoporosis). Main outcome measures were the Voice Handicap Index-10 (VHI-10), xerostomia scale, acid reflux inquiry, and anxiety/depression scale.
  
  
  RESULTS
  Patients with autoimmune disease were more likely to experience voice symptoms as assessed by the VHI-10 questionnaire (P = .0035). Subgroup analysis showed autoimmune patients were more likely to report voice symptoms regardless of whether they were on a disease-modifying antirheumatic drug (DMARD; P = .0010) or non-DMARD (P = .017), suggesting autoimmune disease may be an independent risk factor from pharmacotherapy. Xerostomia was more common in an autoimmune population compared with the control group (P = .02). A positive correlation between xerostomia and VHI-10 scores was found for the DMARD group (Spearman rank coefficient = 0.49, P < .001). No significant difference in acid reflux inquiry (P = .44) or the anxiety/depression scale (P = .36) was found when comparing the autoimmune and control groups.
  
  
  CONCLUSIONS
  Patients with autoimmune disease have increased likelihood of voice symptoms when compared with a control population with non-autoimmune disease. Further prospective studies to elucidate the cause of voice disorder would be valuable.
authors.affiliation: Ear, Nose & Throat Department, Cambridge University Hospitals NHS Trust, Cambridge, UK. zwl20cam@gmail.com
authors.forename: Zi Wei
authors.initials: ZW
authors.lastname: Liu
authors.forename: Liam M
authors.initials: LM
authors.lastname: Masterson
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Srouji
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.forename: David G I
authors.initials: DG
authors.lastname: Scott
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003240:Connective Tissue Diseases / Q000150:complications / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055013:Osteoarthritis, Spine / Q000150:complications / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014832:Voice Disorders / Q000150:complications / Q000453:epidemiology*; D014987:Xerostomia / Q000150:complications / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents