RESEARCH - Cricothyroid joint (CTJ) abnormalities in patients with RA

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J Voice. 2010 Mar 22.

Cricothyroid Joint Abnormalities in Patients With Rheumatoid Arthritis

Berjawi G, Uthman I, Mahfoud L, Husseini ST, Nassar J, Kotobi A, Hamdan AL.

Radiology Department, American University of Beirut, Beirut, Lebanon.

Abstract

The objective of this study was to assess structural and functional

abnormalities of the cricothyroid joint (CTJ) in patients with

advanced rheumatoid arthritis (RA). A total of 19 subjects-11 patients

with advanced RA and eight normal controls-were considered. All

subjects underwent laryngeal endoscopy, acoustic analysis, and

high-resolution computerized tomography (HRCT). Vocal symptoms, such

as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired

and acoustic parameters, mainly pitch range, fundamental frequency,

habitual pitch, perturbation parameters, and noise-to-harmonic ratio

(NHR) and voice turbulence index were measured. Frequencies and means

were calculated for categorical and continuous variables. Cases and

controls were compared with respect to acoustic analysis, HRCT

findings and laryngeal symptoms using nonparametric tests,

Mann-Whitney U test for continuous variables and Fishers exact test

for categorical variables. Almost half of the patients with RA had

loss range and two-thirds had vocal fatigue. Thirty-six percent

experienced hoarseness compared with 25% in the control group. 9.1%

had decrease in vocal fold mobility and 27% had moderate/severe edema

of the vocal folds/arytenoids compared with none in the control group.

HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1%

compared with none in the control group. 45.5% had an increase in the

CTJ density compared with 12.5% in the control group. Acoustic

analysis revealed significant decrease in pitch range and maximum

phonation time (MPT) and significant increase in perturbation

parameters.

CTJ is commonly affected in patients with RA. Functional disabilities

are crucial especially in professional voice users. Proper awareness

is important for early detection and intervention.

PMID: 20335001

http://www.ncbi.nlm.nih.gov/pubmed/20335001

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