Case Report: Upper airway obstruction due to rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by inflammation of small joints. Small synovial joints in the larynx can also become affected, and laryngeal involvement is seen in more than half of patients with RA. As most patients have subtle symptoms and indolent course, they are either misdiagnosed or undiagnosed. The acute worsening of cricoarytenoid arthritis can cause sudden upper airway obstruction and may require emergency intubation or tracheostomy. This life-threatening condition is described in only a handful of cases in the medical literature. Physicians should be aware of this rare but life-threatening consequence of RA. We present a case of sudden and severe upper airway obstruction secondary to laryngeal involvement in a patient with long-standing RA.

Keywords: Odontoid fracture; Rheumatoid arthritis; Upper airway obstruction; cricoarytenoid joint.

Figure 1.. CT scan of the cervical neck showing Type II odontoid fracture (blue arrow) and sclerosis of the arytenoid cartilage (yellow arrow).

Figure 2.. Video bronchoscopy images showing enlarged arytenoid appendages (yellow arrows).

Endotracheal tube (blue arrow) can be seen entering the vocal cords.