Cricoarytenoid Joint Arthritis: Signs, Causes, and Treatment

The cricoarytenoid joints, a pair of small joints in the back wall of the larynx (voice box), can be affected by rheumatoid arthritis (RA). These joints open, close, and tighten the vocal cords during speech and breathing.

Symptoms of arthritis in the cricoarytenoid joint include hoarseness, painful swallowing, feeling like something is stuck in your throat, shortness of breath, and loud breathing. It can often be managed by treating the underlying autoimmune disease.

This article discusses cricoarytenoid joints and arthritis. It explains the anatomy of the cricoarytenoid joints and how RA may affect them. It also describes the symptoms, diagnosis, and treatment of cricoarytenoid arthritis.

Anatomy and Uses of Cricoarytenoid Joint

The cricoarytenoid joints are two small joints in the back of the larynx between the cricoid and arytenoid cartilage. These joints are used to manipulate the vocal cords when you talk, sing, hum, or breathe.

The cricoarytenoid joints have a shallow ball-and-socket design, which allows them to move in rotating and gliding motions to adjust the tone and pitch of your voice. They are covered by synovial membranes, a thin, fluid-filled lining composed of connective tissue.

Rheumatoid arthritis is an autoimmune condition where the body attacks the synovium, causing inflammation in and around the joints. RA of the cricoarytenoid joints can not only affect your voice but can impact breathing as well.

Symptoms of Arthritis in the Cricoarytenoid Joint

Not everyone who has abnormalities involving the cricoarytenoid joint experiences symptoms, and the reasons behind this are not well understood. In some cases, symptoms begin even before there are observable changes in the joint.

Symptoms of cricoarytenoid arthritis include:

• Hoarseness
• Pain when swallowing (odynophagia)
• Feeling like something is stuck in your throat
• Pain when talking or coughing
• Shortness of breath (dyspnea)
• Harsh or grating sound while breathing (stridor)

If you have these symptoms, don't pass them off as being something minor. Sometimes the hoarseness and breathing problems are the only signs that someone has RA or another rheumatic disease.

Causes and Risk Factors for Cricoarytenoid Arthritis

RA affects joints by causing inflammation in the synovium, which is the lining of the joint. This spreads to the surfaces of the bones and causes fibrosis, which can eventually lead to rigidity and immobility known as ankylosis.

When this happens in the cricoarytenoid joint, it becomes less able to move the vocal cords or assist in breathing. Studies show cricoarytenoid joint involvement occurs in up to 70% of people with RA.

When cricoarytenoid arthritis is part of RA and other autoimmune diseases, symptoms are caused by the immune system attacking the joint or associated structures as if they were a dangerous pathogen instead of a normal part of the body.

Cricoarytenoid arthritis is most common in people with RA, but it can also occur in other autoimmune diseases, including:

• Sjögren's syndrome
• Ankylosing spondylitis
• Lupus
• Juvenile idiopathic arthritis
• Autoimmune hepatitis
• Dermatomyositis

When cricoarytenoid arthritis is part of RA and other autoimmune diseases, symptoms are caused by the immune system attacking the joint or associated structures as if they were a dangerous pathogen instead of a normal part of the body.

Diagnosing Cricoarytenoid Arthritis

When cricoarytenoid arthritis occurs as part of a previously diagnosed disease, healthcare providers may use various imaging techniques to look at the larynx, including:

• Laryngoscopy: A laryngoscope (a long, thin instrument including a light and small video camera) is inserted through your mouth or nose to examine your larynx and other structures in your throat; alternatively, a light is shined at the back of your throat while the healthcare provider uses a mirror to get a look.
• Microlaryngoscopy: This surgical procedure uses a laryngoscope with a microscope to examine the larynx, evaluate airway obstruction, and possibly remove some tissue for biopsy.
• Electromyography (EMG): This test uses electrodes to stimulate nerves and measure muscle response; it can help healthcare providers diagnose neuromuscular problems.
• Computed tomography (CT) scan: Multiple X-ray images are taken and combined into a 3D image of the larynx and other structures in the throat.

A physical exam will likely include palpating (pushing on and manipulating) the cricoarytenoid joint to see if it's stiff or rigid.

If laryngeal symptoms are the first signs of disease, your healthcare provider may begin by checking for specific autoimmune diseases based on your symptoms and history. Blood tests may look for:

• Inflammatory markers, including erythrocyte sedimentation rate (ESR or sed rate), C-reactive protein (CRP) test, and plasma velocity (PV)
• Autoantibodies (antibodies that attack healthy tissues)
• Rheumatoid factor (RF), which can indicate RA
• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP)

Treatment for Cricoarytenoid Arthritis

Because cricoarytenoid arthritis is a consequence of other diseases, treating the underlying disease may help ease symptoms. This could include the use of immunosuppressive and anti-inflammatory medications.

Specific treatment for mild symptoms of cricoarytenoid arthritis usually begins with high-dose systemic corticosteroids. If that doesn't work, an injection of corticosteroids into the cricoarytenoid joint may be required.

In certain situations in which the arthritis is interfering with breathing or speech and not responding to other treatments, surgery may be an option. Procedures can include:

• Tracheostomy: An emergency surgery that may be needed when breathing becomes seriously blocked, this involves creating a hole in your windpipe and inserting a tube to serve as an alternative airway.
• Arytenoidectomy: Generally performed to maintain an open airway after tracheostomy, this procedure involves removal of laryngeal cartilage to which the vocal cords are attached.
• Arytenoidopexy: The cartilage at the back of the larynx is fixed in place surgically to restore loss of voice due to total vocal cord paralysis.

Summary

The cricoarytenoid joints, a pair of tiny ball-and-socket joints that manipulate the vocal cords, can be affected by rheumatoid arthritis. In RA, the immune system mistakenly attacks the synovial tissue that lines joints, causing inflammation and joint pain. 

Signs of cricoarytenoid arthritis include hoarseness, stridor, and pain when swallowing, talking, or coughing. It is diagnosed using imaging tests, such as a laryngoscopy or CT scan, along with a physical exam and blood work. 

Rheumatoid arthritis of the cricoarytenoid joints is treated with immunosuppressive and anti-inflammatory medications that target the underlying disease. If it is interfering with your breathing, surgery may be needed to keep your airways open.