A newly published case report describes an exceptionally rare cause of bilateral vocal cord immobility secondary to psoriatic arthritis. The researchers suggest clinicians consider rheumatologic disease in patients with unexplained voice and breathing abnormalities.
The report details the case of a man in his late 60s with a longstanding history of psoriatic arthritis who presented with a 10-year history of hoarseness and exertional dyspnea, wrote lead study author Kyle Tong of the University of Ottawa, and colleagues. Flexible laryngostroboscopy revealed bilateral immobility of the true vocal cords, which were fixed in paramedian positions, resulting in significant narrowing of the glottic airway.
To evaluate for more common causes, including recurrent laryngeal nerve injury or malignancy, contrast-enhanced computed tomography of the neck was performed. Imaging confirmed findings consistent with vocal cord immobility. No lesions were identified along the recurrent laryngeal nerves, according to the case report, and there was no evidence of malignancy or thyroid disease.
The researchers concluded that cricoarytenoid joint fixation due to psoriatic arthritis was the most likely cause. Retrospective review of imaging obtained 8 years earlier demonstrated similar, stable findings, further supporting a chronic inflammatory process.
Cricoarytenoid arthritis is a recognized manifestation of several autoimmune and inflammatory diseases, most commonly rheumatoid arthritis. Its association with psoriatic arthritis is exceedingly rare; the researchers noted that this represents only the second documented case in the literature, following a report published in 2021.
Management options, including tracheotomy and laser posterior cordotomy with or without partial arytenoidectomy, were discussed with the patient. Given the stability of his symptoms and adequate airway, a shared decision was made to pursue conservative management without surgical intervention.
Although rare, cricoarytenoid joint involvement in psoriatic arthritis can lead to significant airway compromise, according to the researchers. Early recognition through clinical evaluation and imaging is important, as bilateral involvement may result in life-threatening obstruction
"Healthcare providers should be aware of this potential complication, particularly in [patients with psoriatic arthritis] presenting with voice changes, breathing difficulties, or throat symptoms with no other identifiable cause," according to the case report. "Early clinical and radiological recognition and appropriate treatment are crucial, as bilateral cricoarytenoid joint involvement can lead to life-threatening airway obstruction requiring emergency intervention."
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Source: Ear, Nose & Throat Journal
