Arthritis of the joints of the larynx: causes, symptoms, diagnosis, treatment

Arthritis of the laryngeal joints occurs primarily and secondarily. Primary arthritis is caused by rheumatoid infection and manifests itself along with damage to other joints - hands, feet, less often larger joints (rheumatoid and rheumatic polyarthritis).

Rheumatoid arthritis, according to T.M. Trofimov (1989), is an inflammatory disease of the joints, characterized by a chronic progressive course and is one of the most common joint diseases. The cause of this disease is unknown. Great importance is attached to the autoimmune process, the peculiarity of which is the production of lymphocytes and antibodies (autoantibodies) against the body's own tissues. At the onset of the disease, swelling of the joints is observed, later subluxations, contractures and ankylosis of them are formed. Their function is gradually impaired. With rheumatoid arthritis, in addition to polyarthritis, enlarged lymph nodes, the formation of subcutaneous painless nodules, most often located near the elbow joints (rheumatoid nodules), signs of damage to the peripheral nervous system (neuritis) and internal organs (heart, lungs, kidneys) can be observed. In some cases, body temperature rises, sometimes up to 38-39 ° C. The above-mentioned phenomena of rheumatoid arthritis represent important differential diagnostic signs that distinguish rheumatoid arthritis of the larynx from common arthritis, which is a complication of the vulgar diseases described above.

Rheumatism, according to the definition of N.N. Kuzmin (1989), is a systemic inflammatory disease of connective tissue, characterized by the predominant localization of the process in the cardiovascular system and developing in predisposed individuals, mainly young people, due to an infection caused by beta-hemolytic streptococcus group A. A feature of this disease is its epidemiological penetrance in young groups (child care institutions, military units, etc.). It has been established that the onset of the disease or its relapse is preceded by tonsillitis, pharyngitis, rhinitis or scarlet fever. Beta-hemolytic streptococcus group A is often cultured from smears from the mucous membrane of the nasopharynx of patients, and an increased content of antistreptococcal antibodies is found in the blood serum. Confirmation of the role of streptococcal infection in the development of rheumatism, and in particular rheumatic laryngeal arthritis, along with the above symptoms, is the possibility of preventing its development with proper treatment of this infection with penicillin and prevention of relapses by prescribing bicillin.

Sometimes arthritis of the laryngeal joints occurs due to gonococcal infection, as a result of endolaryngeal iatrogenic trauma (during esophagoscopy, laryngobronchoscopy, tracheal intubation for anesthesia, esophageal probing, foreign body extraction), foreign body trauma as well as during extremely strong vocal strain. If arthritis of the larynx is caused by a rheumatic process or gout, it takes on a protracted chronic nature.

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Pathological anatomy

Pathological changes in arthritis of the laryngeal joints vary depending on the etiologic factor. In banal processes, inflammatory changes are limited to serous synovitis with subsequent fibrinous changes in the joint bags. In more severe arthritis, purulent inflammation develops, which is sometimes accompanied by necrosis. After the elimination of the inflammatory process, in most cases, ankylosis of the joint and cicatricial changes develop, limiting its function. In infectious and specific arthritis, the pathological picture is characterized by specific features of each disease separately (diphtheria, scarlet fever, tuberculosis, syphilis, etc.).

Arthritis of the cricoarytenoid joint

The cause of this disease can be both banal and infectious-specific diseases of the larynx, as a result of perichondritis of the larynx, phlegmon or abscess of the pharynx and, as noted above, as a result of rheumatoid and rheumatic processes, gout, gonococcal infection, etc. Transmission of infection can occur by contact (per continuitatem), hematogenous or lymphogenous route. Etiological factors are most often hemolytic streptococcus, staphylococcus and polymicrobial association. In infectious and specific diseases, along with the banal microbiota, there is also a specific one, determining the general clinical picture of this particular disease.

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Symptoms of cricoarytenoid arthritis

In acute forms of arthritis of the cricoarytenoid joint, the signs of the disease are very similar to the symptoms of perichondritis of the arytenoid cartilage: dysphonia, dysphagia, edema of the corresponding area of the larynx, etc. The vocal fold on the affected side is limited in movement or completely immobile. This condition differs from its neurogenic lesion (neuritis or injury of the corresponding recurrent nerve) in that the mucous membrane in the area of the arytenoid cartilage is hyperemic, edematous, the contours of the cartilage are smoothed. The vocal fold in this case occupies either an intermediate position between the positions during its abduction and adduction (intermediate position), or a position approaching the median (paramedial position). If bilateral arthritis of the cricoarytenoid joint occurs, then in the paramedian position, suffocation occurs, often requiring emergency tracheotomy (for all stenosis of the larynx of inflammatory-infectious origin, requiring emergency care, a lower tracheotomy is performed, preferably at the level of the 3-4th ring of the trachea, away from the source of inflammation, so as not to cause infection of the tracheostomy).

After the acute symptoms disappear, the joint area remains swollen for some time, its mobility is limited, which affects the phonatory function of the larynx. When permanent ankylosis of the affected joint occurs, the phenomenon of repercussion weakening of the function of the recurrent nerve on the affected side is observed as a result of atrophy of the neuromuscular apparatus from "lack of activity".

Diagnosis of arthritis of the cricoarytenoid joint

Diagnosis of arthritis of the cricoarytenoid joint does not cause difficulties in the inflammatory genesis of arthritis of the laryngeal joints, it is more difficult in rheumatoid and rheumatic arthritis. In the latter case, differential diagnosis is based on general and local signs of the underlying disease. Ankylosis of the cricoarytenoid joint is differentiated from neuromuscular dysfunction in unilateral damage to the recurrent nerve based on the fact that in the first case, the vocal process of the cartilage is located obliquely downwards in the direction of the lumen of the larynx and moves with the movement of the opposite vocal fold, while with ankylosis of the joint, movements of the arytenoid cartilage are impossible. The absence of movements in the cricoarytenoid joint can be established by an attempt to set the arytenoid cartilage in motion during direct laryngoscopy.

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Arthritis of the cricothyroid joint

Arthritis of the cricothyroid joint occurs for the same reasons as the cricoarytenoid joint. It is diagnosed by the fact that when pressing on the lateral plates of the thyroid cartilage, sharp pain occurs in the depth of the larynx during phonation of high sounds, radiating to the corresponding half of the neck, sometimes to the ear, and also on the basis of spontaneous pain. Endoscopically, signs of inflammation of the corresponding half of the larynx in the area of the cricoarytenoid joint are detected.

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Treatment of arthritis of the laryngeal joints

Treatment for laryngeal arthritis is carried out in accordance with the etiology of the disease and the pathological anatomical state of its current condition.

Laryngeal arthritis prognosis

The prognosis regarding the functions of the larynx is favorable in rheumatoid and rheumatic arthritis, less favorable in gout (salt deposition in the joints) and cautious in arthritis of banal etiology, which is most prone to the formation of joint ankylosis.