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Canadian Journal of Anaesthesia

, Volume 49, Issue 7, pp 729–732 | Cite as

Cricoarytenoid arthritis: a cause of acute upper airway obstruction in rheumatoid arthritis

  • Jacelyn KolmanEmail author
  • Ian Morris
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

To report acute upper airway obstruction due to cricoarytenoid arthritis, a well known but uncommon complication of rheumatoid arthritis.

Clinical features

We report the case of a 70-yr-old female scheduled for a colostomy who had been suffering from rheumatoid arthritis for 17 years. Preoperative history and physical examination revealed no cardiopulmonary compromise. Anesthesia was induced while an assistant immobilized the cervical spine and an atraumatic intubation was performed. Surgery was uneventful. Muscle paralysis was reversed, demonstrated by normalization of the train-of-four response, and the patient was extubated awake. Shortly postextubation, the patient developed inspiratory stridor, which disappeared after a second dose of neostigmine. The patient was transported to the postanesthesia care unit. Just prior to arrival the patient once again developed inspiratory stridor, became distressed, and oxygen saturation decreased. Direct laryngoscopy followed by a nasal fibreoptic examination of the larynx was performed. Cricoarytenoid arthritis secondary to rheumatoid arthritis with airway compromise was diagnosed. An uneventful awake tracheostomy was performed. The patient was discharged on day ten with a colostomy and a tracheostomy in place. One month postdischarge the patient’s trachea was decannulated. On follow-up, a normal voice and mobile cords were observed.

Conclusion

Cricoarytenoid arthritis is an infrequent complication of rheumatoid arthritis. Athorough history and physical examination are necessary to recognize signs and symptoms of cricoarytenoid arthritis. Prompt recognition of airway obstruction due to cricoarytenoid arthritis is essential for appropriate management.

Keywords

Rheumatoid Arthritis Airway Obstruction Vocal Cord Neostigmine Direct Laryngoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’arthrite crico-aryténoïdienne: une cause d’obstruction des voies respiratoires supérieures dans l’arthrite rhumatoïde

Résumé

Objectif

Présenter un cas d’obstruction des voies respiratoires supérieures provoquée par l’arthrite crico-aryténoïdienne, une complication rare, mais bien connue, de l’arthrite rhumatoïde.

Éléments cliniques

Il s’agit d’une femme de 70 ans, souffrant d’arthrite rhumatoïde depuis 17ans, qui devait subir une colostomie. Lanamnèse préopératoire et l’examen physique n’ont révélé aucune atteinte cardiopulmonaire. Lanesthésie a été induite pendant l’immobilisation de la colonne cervicale par un assistant, puis l’intubation atraumatique a été réalisée, L’intervention chirurgicale s’est bien déroulée. La paralysie musculaire a été renversée, prouvée par la normalisation de la réponse en trainde-quatre, et l’extubation vigile a été pratiquée. Peu après, un stridor s’est développé et a disparu à la suite d’une seconde dose de néostigmine. La patiente a été transportée à la salle de réveil. Juste avant l’arrivée, le stridor est apparu de nouveau, accompagné de détresse et d’une baisse de la saturation en oxygène. On a procédé à une laryngoscope directe suivie d’un examen fibroscopique nasal du larynx. Larthrite cricoaryténoïdienne secondaire à l’arthrite rhumatoïde, avec obstruction des voies respiratoires, a été diagnostiquée. Une trachéotomie vigile a été faite, sans incident. La patiente a quitté l’hôpital au dixième jour avec une colostomie et une trachéostomie en place. La canule trachéale a été enlevée un mois après. La voix était normale et les cordes vocales mobiles lors du suivi.

Conclusion

L’arthrite cricoaryténoïdienne est une complication rare de l’arthrite rhumatoïde. Une anamnèse fouillée et un examen minutieux sont nécessaires pour en reconnaître les signes et les symptômes. Le diagnostic rapide d’obstruction des voies aériennes causée par l’arthrite cricoaryténoïdienne est essentiel au traitement approprié.

References

  1. 1.
    Brazeau-Lamontagne L, Charlin B, Levesque RY, Lussier A. Cricoarytenoiditis: CT assessment in rheumatoid arthritis. Radiology 1986; 158: 463–6.PubMedGoogle Scholar
  2. 2.
    Skues MA, Welchew EA. Anaesthesia and rheumatoid arthritis. Anaesthesia 1993; 48: 989–97.PubMedGoogle Scholar
  3. 3.
    Jenkins LC, McGraw RW. Anaesthetic management of the patient with rheumatoid arthritis. Can Anaesth Soc J 1969; 16: 407–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Matti MV, Sharrock NE. Anesthesia on the rheumatoid patient. Rheum Dis Clin North Am 1998; 24: 19–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Phelps JA. Laryngeal obstruction due to cricoarytenoid arthritis. Anesthesiology 1966; 27: 518–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Kandora TF, Gilmore IM, Sorber JA, Kose FB, Matta II. Cricoarytenoid arthritis presenting as cardiopulmonary arrest. Ann Emerg Med 1985; 14: 700–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Bamshad M, Rosa U, Padda G, Luce M. Acute upper airway obstruction in rheumatoid arthritis of the cricoarytenoid joints. South Med J 1989; 82: 507–11.PubMedGoogle Scholar
  8. 8.
    Lofgren RH, Montgomery WW. Incidence of laryngeal involvement in rheumatoid arthritis. N Engl J Med 1962; 267: 193–5.PubMedGoogle Scholar
  9. 9.
    Bienenstock H, Ehrlich GE, Freyberg RH. Rheumatoid arthritis of the cricoarytenoid joint: a clinicopathologic study. Arthritis Rheum 1963; 6: 48–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Polisar IA. The crico-arytenoid joint: a diarthrodial articulation subject to rheumatoid arthritic involvement. Laryngoscope 1959; 69: 1129–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Grossman A, Martin JR, Root HS. Rheumatoid arthritis of the crico-arytenoid joint. Laryngoscope 1961; 71: 530–44.PubMedCrossRefGoogle Scholar
  12. 12.
    Montgomery WW. Cricoarytenoid arthritis. Laryngoscope 1963; 73: 801–36.PubMedCrossRefGoogle Scholar
  13. 13.
    Sellars I, Sellars S. Cricoarytenoid joint structure and function. J Laryngol Otol 1983; 97: 1027–34.PubMedGoogle Scholar
  14. 14.
    von Leden H, Moore P. The mechanics of the cricoarytenoid joint. Arch Otolaryngol 1961; 73: 63–72.Google Scholar
  15. 15.
    Bridger MWM, Jahn AF, van Nostrand AWP. Laryngeal rheumatoid arthritis. Laryngoscope 1980; 90: 296–303.PubMedCrossRefGoogle Scholar
  16. 16.
    Woldorf NM, Pastore PN, Terz J. Rheumatoid arthritis of the cricoarytenoid joint. Arch Otolaryngol 1971; 93: 623–7.PubMedGoogle Scholar
  17. 17.
    Leicht MJ, Harrington TM, Davis DE. Cricoarytenoid arthritis: a cause of larygneal obstruction. Ann Emerg Med 1987; 16: 885–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Lynch JP III, Quint LE. Tracheobronchial and esophageal manifestations of systemic diseases.In: Cummings CW (Ed.). Otolaryngology Head and Neck Surgery, 3rd ed. Missouri: Mosby-Year Book, Inc., 1998: 2343–67.Google Scholar
  19. 19.
    Jurik AG, Pedersen U. Rheumatoid arthritis of the crico-arytenoid and crico-thyroid joints: a radiological and clinical study. Clin Radiol 1984; 35: 233–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Funk D, Raymon F. Rheumatoid arthritis of the cricoarytenoid joints: an airway hazard. Anesth Analg 1975; 54: 742–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Gardner DL, Holmes F. Anaesthetic and postoperative hazards in rheumatoid arthritis. Br J Anaesth 1961; 33: 258–64.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  1. 1.Department of Anesthesia, Queen Elizabeth Health CentreDalhousie UniversityHalifaxCanada

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