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

Arthritis of the larynx joints arise primarily and secondarily. Primary arthritis is caused by rheumatoid infection and manifests, along with the lesion of other joints - brushes, feet, rarely larger joints (rheumatoid and rheumatic polyarthritis).

Rheumatoid arthritis, as defined by TM Trofimov (1989), is an inflammatory joint disease characterized by a chronic progressive course and is one of the most common joint diseases. The cause of this disease is not known. Great importance is attached to the autoimmune process, the feature of which is the production of lymphocytes and antibodies (autoantibodies) against the body's own tissues. At the beginning of the disease, joint swelling is observed, subluxations, contractures and ankyloses are formed later. Their function is gradually broken. In rheumatoid arthritis, in addition to polyarthritis, there may be an increase in lymph nodes, the formation of subcutaneous painless nodules, located most often near the elbow joints (rheumatoid nodules), signs of damage to the peripheral nervous system (neuritis) and internal organs (heart, lungs, nochek). In some cases, body temperature rises, sometimes up to 38-39 ° C. These phenomena of rheumatoid arthritis are important differential diagnostic signs that distinguish rheumatoid arthritis of the larynx from banal arthritis, which is a complication of the vulgar diseases described above.

Rheumatism, according to the definition of NN Kuzmin (1989), is a systemic inflammatory disease of connective tissue, characterized by the predominant localization of the process in the SSS and developing in persons predisposed to it, mainly young, due to infection caused by beta-hemolytic group streptococcus A. The peculiarity of this disease is its epidemiological penetrance in the young age groups (children's educational institutions, military units, etc.). It was established that the onset of the disease or its recurrence is preceded by angina, pharyngitis, rhinitis or scarlet fever. From smears from the mucous membrane of the nasopharynx of the diseased, a beta-hemolytic streptococcus of group A is often sown, and in the blood serum there is an increased content of anti-streptococcal antibodies. Confirmation of the role of streptococcal infection in the occurrence of rheumatism, and in particular rheumatic laryngeal arthritis, along with the above signs, is the possibility of preventing its development with the correct treatment of this infection with penicillin and preventing relapses by prescribing bicillin.

Sometimes arthritis of the joints of the larynx arises due to infection of gonococcal infection, as a result of endolaryngeal iatrogenic trauma (with esophagoscopy, laryngoblocchoscopy, intubation of the trachea for narcosis, probing of the esophagus, removal of the foreign body), foreign body injuries as with superstrong vocal tension. If the arthritis of the larynx is caused by a rheumatic process or gout, then it takes a protracted chronic character.

[1], [2], [3], [4]

Pathological anatomy

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

Arthritis of the metacarpal joint

The cause of this disease can serve as banal and infectious-specific diseases of the larynx, as a result of the appearance of laryngeal periendritis, phlegmon or pharynx abscess and, as already 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 pathway. 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, determining the overall clinical picture of this particular disease.

[5], [6], [7], [8]

Symptoms of arthritis of the cicatrice joint

In acute forms of arthritis of the periuterotrophic joint, the symptoms of the disease are very similar to the symptoms with perihedrite of the arytenoid cartilage: dysphonia, dysphagia, edema of the corresponding region of the larynx, etc. The voice fold on the side of the lesion is limited in movements or completely immobile. This condition differs from its neurogenic lesion (neuritis or trauma of the corresponding recurrent nerve) in that the mucosa in the arytenoid cartilage region is hyperemic, edematic, the outlines of the cartilage are smoothed. The voice fold thus occupies either an intermediate position between the positions when it is withdrawn and brought (intermediate position), or a position approaching the median (paramedial position). If bilateral bilateral arthritis arises, then in the paramedical situation, suffocation phenomena occur, often requiring an emergency tracheotomy (for all stenoses of the larynx of the inflammatory-infectious disease requiring urgent care, the lower tracheotomy is produced, preferably at the level of the 3rd and 4th tracheal rings, away from a focus of inflammation to prevent infection of the tracheostomy).

After the disappearance of acute phenomena, the area of the joint remains for some time edematic, its mobility is limited, which affects the laryngeal function of the larynx. When there is a permanent ankylosis of the affected joint, the phenomenon of repercussive weakening of the function of the recurrent nerve on the side of the lesion as a result of the atrophy of the neuromuscular apparatus from "lack of activity" is observed.

Diagnosis of arthritis of the cicatrice

Diagnosis of arthritis of the pustnestherpalovogo joint does not cause difficulties in the inflammatory genesis of arthritis of the laryngeal joints, it is more difficult for rheumatoid and rheumatoid arthritis. In the latter case, differential diagnosis is based on general and local signs of the underlying disease. From neuromuscular dysfunction with unilateral damage to the recurrent nerve, ankylosis of the pericoptera pectoral joint is differentiated on the basis of the fact that in the first case the cartilage voice process is obliquely downward in the direction of the laryngeal lumen and moves with the movement of the opposite voice fold, while ankylosis of the joint movement of the arytenoid cartilage is impossible. The absence of movements in the percutaneous fascicle can be established by an attempt to set the arytenoid cartilage in direct laryngoscopy.

[9], [10], [11], [12]

Arthritis of the transperitoneal joint

Arthritis of the transperitoneal joint arises for the same reasons as the pustnestherpalovidnogo joint. It is diagnosed by the fact that when pressing on the side plates of the thyroid cartilage there is a sharp soreness in the depth of the larynx when the high sounds flash, radiating to the corresponding half of the neck, sometimes in the ear, and also on the basis of spontaneous pains. Endoscopy reveals signs of inflammation of the corresponding half of the larynx in the area of the pustchnecherpalovodnogo joint.

[13], [14], [15]

Treatment of arthritis of the joints of the larynx

Treatment for arthritis of the larynx is carried out in accordance with the etiology of the disease and pathoanatomical state of its current state.

Prognosis of laryngeal arthritis

The prognosis for laryngeal functions is favorable for rheumatoid and rheumatoid arthritis, less favorable for gout (deposition in the joints of salts) and cautious for arthritis of common etiology, most prone to the formation of joint ankylosis.