Research Article| Volume 34, ISSUE 3, P451-455, May 2020

Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients

Published:November 16, 2018DOI:



      To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA).

      Study design

      Prospective clinical study.


      Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux.


      Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase.


      RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.

      Key Words

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      1. Gümüşdiş, G. Bağ Dokusu Hastalıkları: Romatoid Artrit. G. Gümüşdiş, E. Doğanavşargil (eds). Klinik Romatoloji, Deniz Matbaası, sf: 269-279, İstanbul 1999.

      2. Koopman WH. Arthritis and Allied Conditions. Lippincott Williams and Wilkins, Philadelphia, 2001.

      3. Fresko, İ. Romatoid Artritin Eklem Dışı Bulguları. V. Hamuryudan. (ed). Romatoid Artrit, MD Yayıncılık, sf: 20-24, Ankara 2002.

        • Hamdan A.L.
        • El-Khatib M.
        • Dagher W.
        • Othman I.
        Laryngeal involvement in rheumatoid arthritis.
        Middle East J Anesthesiol. 2007; 19: 335-344
        • Voulgari P.V.
        • Papazisi D.
        • Bai M.
        • Zagorianakou P.
        • Assimakopoulos D.
        • Drosos A.A.
        Laryngeal involvement in rheumatoid arthritis.
        Rheumatol Int. 2005; 25: 321-325
        • Amernik K.
        • Tarnowska C.
        • Brzosko I.
        • Grzelec H.
        • Burakl M.
        Glottis morphology in rheumatoid arthritis.
        Otolaryngol Pol. 2007; 61: 85-90
        • Berjawi G.
        • Uthman I.
        • Mahfoud L.
        • Husseini S.T.
        • Nassar J.
        • Kotobi A.
        • Hamdan A.L.
        Cricothyroid joint abnormalities in patients with rheumatoid arthritis.
        J Voice. 2010; 24: 732-737
        • Gómez-Puerta J.A.
        • Cisternas A.
        • Hernández M.V.
        • Ruiz-Esquide V.
        • Vilaseca I.
        • Sanmartí R.
        Valoración laríngea mediante videolaringoestroboscopia en pacientes con artritis reumatoide.
        Reumatol Clin. 2014; 10: 32-36
        • Vilaseca I.
        Videolaringoestroboscopia: una técnica para visualizar las cuerdas vocales.
        EFE. 2008; 17: 417-432
        • Aletaha D.
        • Ward M.M.
        • Machold K.P.
        • Nell V.P.K.
        • Stamm T.
        • Smolen J.S.
        Remission and active disease in rheumatoid arthritis. Defining criteria for disease activity states.
        Arthritis Rheum. 2005; 52: 2625-2636
        • Beirith S.C.
        • Ikino C.M.
        • Pereira I.A.
        Laryngeal involvement in rheumatoid arthritis.
        Braz J Otorhinolaryngol. 2013; 79: 233-238
        • Castro M.A.
        • Dedivitis R.A.
        • Pfuetzenreiter Júnior E.G.
        • Barros A.P.
        • Queija Ddos S.
        Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis.
        Braz J Otorhinolaryngol. 2012; 78: 121-127
        • Hosako Y.
        • Nakamura M.
        • Tayama N.
        • et al.
        Laryngeal involvements in systemic lupus erythematosus: a case report.
        Larynx. 1993; 5: 171-175
        • Friedman B.A.
        Rheumatoid nodules of the larynx.
        Arch Otolaryngol. 1975; 101: 361-363
        • Ramos H.V.
        • Pillon J.
        • Kosugi E.M.
        • Fujita R.
        • Pontes P.
        Laryngeal assessment in rheumatic disease patients.
        Braz J Otorhinolaryngol. 2005; 71: 499-503
        • Upile T.
        • Jerjes W.
        • Sipaul F.
        • Singh S.
        • Hopper C.
        • Wright A.
        • Sandison A.
        Rheumatoid nodule of the thyrohyoid membrane: a case report.
        J Med Case Rep. 2007; 1: 123
        • Hamdan A.L.
        • Sarieddine D.
        Laryngeal manifestations of rheumatoid arthritis.
        Autoimmune Dis. 2013; 2013103081
        • Belafsky P.C.
        • Postma G.N.
        • Koufman J.A.
        The validity and reliability of the reflux finding score (RFS).
        Laryngoscope. 2001; 111: 1313-1317
        • Myasoedova E.
        • Talley N.J.
        • Manek N.J.
        • Crowson C.S.
        Prevalence and risk factors of gastrointestinal disorders in patients with rheumatoid arthritis: results from a population-based survey in Olmsted county, Minnesota.
        Gastroenterol Res Pract. 2011; 745829
        • Hah J.H.
        • An S.Y.
        • Sim S.
        • Kim S.Y.
        • Oh D.J.
        • Park B.
        • Kim S.G.
        • Choi H.G.
        A population-based study on the association between rheumatoid arthritis and voice problems.
        Clin Rheumatol. 2016; 35: 1873-1878
        • Kosztyła-Hojna B.
        • Moskal D.
        • Kuryliszyn-Moskal A.
        Parameters of the assessment of voice quality and clinical manifestation of rheumatoid arthritis.
        Adv Med Sci. 2015; 60: 321-328
        • Roy N.
        • Tanner K.
        • Merrill R.M.
        • Wright C.
        • Miller K.L.
        • Kendall K.A.
        Descriptive epidemiology of voice disorders in rheumatoid arthritis: prevalence, risk factors, and quality of life burden.
        J Voice. 2016; 30: 74-87