Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily targets the body’s joints, causing pain, swelling, and stiffness. While RA is most commonly known for affecting the hands and feet, it is a systemic condition, meaning it can cause inflammation throughout the entire body, including areas that might seem unexpected. Yes, rheumatoid arthritis can affect the throat, specifically the voice box, or larynx. This involvement occurs because the disease targets a particular type of joint found in that area, leading to symptoms that can range from a persistent sore throat to serious breathing difficulties.
Understanding Rheumatoid Arthritis as a Systemic Condition
Rheumatoid arthritis is categorized as a systemic disease because the immune system mistakenly attacks the synovium, the lining of the joints, causing widespread inflammation. This autoimmune response is not limited to large or small joints; any joint containing a synovial membrane is vulnerable to this inflammatory attack. The disease process involves immune cells releasing inflammatory signaling proteins, or cytokines, which leads to the thickening of the synovial tissue. Over time, this inflamed tissue can invade and destroy the cartilage and bone, causing permanent damage and loss of function. This systemic nature also explains why RA can cause extra-articular manifestations, affecting organs like the lungs, eyes, and blood vessels. The presence of synovial tissue in the throat provides a clear pathway for RA to manifest there.
The Cricoarytenoid Joint: The Primary Target
The key anatomical structure affected by RA in the throat is the cricoarytenoid (CA) joint, located in the larynx. This joint is a true diarthrodial joint, lined with a synovial membrane and lubricating fluid, making it susceptible to the same inflammatory process that affects other joints. The CA joints are small, shallow ball-and-socket joints situated between the cricoid and arytenoid cartilages. They are responsible for the intricate movements of the vocal cords, controlling their opening, closing, and tension during speaking and breathing. When RA attacks the CA joint, it causes swelling, pain, and tissue proliferation, known as cricoarytenoid arthritis. Acute inflammation can temporarily restrict movement, while chronic inflammation leads to cartilage erosion, scarring, and eventual fixation (ankylosis). This fixation prevents the vocal cords from moving correctly, directly impacting voice and breathing function.
Recognizing Symptoms of Laryngeal Involvement
Symptoms of laryngeal involvement in RA can be subtle and may often be mistaken for a common cold, allergy, or acid reflux. The most frequently reported symptom is hoarseness (dysphonia), which occurs because inflammation or fixation prevents the vocal cords from vibrating normally. This voice change can range from a slight roughness to intermittent loss of voice.
Patients may also experience pain or discomfort when swallowing (odynophagia), or a persistent sensation of a lump in the throat (globus pharyngeus). In the acute phase, inflammation may cause a tender throat or pain that radiates to the ears. While many individuals with cricoarytenoid joint changes remain asymptomatic, symptoms can be persistent.
The most serious complication is acute airway obstruction, which requires immediate medical attention. This life-threatening event occurs if severe swelling of the joint and surrounding tissues restricts the airway opening. Emergency symptoms include shortness of breath, difficulty breathing, or a high-pitched, harsh sound during inhalation called stridor. Airway symptoms can be aggravated during an upper respiratory tract infection or a severe disease flare.
Diagnosis and Management of Throat Complications
Diagnosing RA-related throat involvement requires collaboration between a rheumatologist and an otolaryngologist (ENT specialist). Diagnosis often begins with a high degree of suspicion when a patient with RA reports persistent or worsening throat symptoms. A definitive diagnosis relies on a visual examination of the larynx.
The ENT specialist performs a laryngoscopy, often using a flexible scope passed through the nose, to directly visualize the vocal cords and the cricoarytenoid joints. During a flare, the joints may appear red and swollen; chronic cases may show decreased mobility or fixation of the vocal cords. Imaging techniques, such as high-resolution computed tomography (CT) scans, complement the visual exam by revealing structural changes like joint erosion, narrowing of the joint space, or soft tissue swelling.
Management focuses on treating the underlying systemic inflammation of rheumatoid arthritis. Optimizing the patient’s current regimen of disease-modifying antirheumatic drugs (DMARDs) and biologic therapies is the primary strategy to control inflammation affecting the throat joints. For acute, severe symptoms, a doctor may prescribe high-dose systemic corticosteroids to quickly reduce swelling. A localized corticosteroid injection directly into the affected cricoarytenoid joint may be considered. In the rare event of severe airway obstruction, surgical intervention, such as a temporary or permanent tracheostomy, may be necessary.