Determination of the Voice Parameters in Adult Individuals With Rheumatoid Arthritis and the Relation of Voice With Depression and Inflammation

Published:October 07, 2020DOI:



      To assess, through both objective and subjective methods, the complaints of dysphonia among adults with rheumatoid arthritis (RA). The secondary purpose of the study is to determine whether complaints of dysphonia are related to depression and disease activity.

      Study Design

      This is a prospective cohort study.


      Eighty subjects (38 RA and 42 healthy volunteers aged 18–65 years old) were included in the study. Participants were evaluated using the Voice Handicap Index-10 (VHI-10) to assess voice complaints. Laryngeal findings of participants with RA were performed by videolaryngoscopy. Maximum phonation time (MPT) measurements and acoustic voice analysis (PRAAT software) were performed to evaluate the presence of objective dysphonia. Disease activity of individuals was calculated by using Disease Activity Score-28 (DAS-28) scale. Beck Depression Inventory (BDI) was applied to evaluate the symptoms of depression in participants.


      The prevalence of laryngeal symptoms of participants with RA was %42.1. According to the cut-off score of VHI-10, 15.8% of the participants in the study group had voice complaints. Comparing the MPT and acoustic voice analyses values of the study and control group, the MPT of the RA participants were statistically lower (P< 0.05). Perturbation parameters of male participants in the study and control groups were statistically different. 15.8% of participants in RA group had symptoms of depression. However, there was no statistically significant difference between BDI and acoustic voice parameters.


      RA may be associated with voice disorders. Male patients with RA had worse jitter parameters, but the number of participants was low. Dysphonia may not be associated with depression and disease activity in RA patients.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grassi W
        • De Angelis R
        • Lamanna G
        • et al.
        The clinical features of rheumatoid arthritis.
        Eur J Radiol. 1998; 27: S18-S24
        • Gulati M
        • Farah Z
        • Mouyis M
        Clinical features of rheumatoid arthritis.
        Medicine (Baltimore). 2018; 46: 211-215
        • Margaretten M
        • Julian L
        • Katz P
        • et al.
        Depression in patients with rheumatoid arthritis: description, causes and mechanisms.
        Int J Clin Rheumatol. 2011; 6: 617
        • Beirith SC
        • Ikino CMY
        • Pereira IA
        Laryngeal involvement in rheumatoid arthritis.
        Brazilian J Otorhinolaryngol. 2013; 79: 233-238
        • Roy N
        • Tanner K
        • Merrill RM
        • et al.
        Descriptive epidemiology of voice disorders in rheumatoid arthritis: prevalence, risk factors, and quality of life burden.
        J Voice. 2016; 30: 74-87
        • Hilgert E
        • Toleti B
        • Kruger K
        • et al.
        Hoarseness due to bamboo nodes in patients with autoimmune diseases: a review of literature.
        J Voice. 2008; 22: 343-350
        • Ylitalo R
        • Heimbürger M
        • PÅ Lindestad
        Vocal fold deposits in autoimmune disease an unusual cause of hoarseness.
        Clin Otolaryngol Allied Sci. 2003; 28: 446-450
        • de Castro MAF
        • Dedivitis RA
        • Pfuetzenreiter EG
        • et al.
        Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis.
        Brazilian J Otorhinolaryngol. 2012; 78: 121-127
        • Hah JH
        • An SY
        • Sim S
        • et al.
        A population-based study on the association between rheumatoid arthritis and voice problems.
        Clin Rheumatol. 2016; 35: 1873-1878
        • Sanz L
        • Sistiaga JA
        • Lara AJ
        • et al.
        The prevalence of dysphonia, its association with immunomediated diseases and correlation with biochemical markers.
        J Voice. 2012; 26: 148-153
        • Kiliç MA
        • Okur E
        • Yildirim I
        • et al.
        Reliability and validity of the Turkish version of the voice handicap index.
        Kulak Burun Bogaz Ihtisas Dergisi. 2008; 18: 139-147
        • Behlau M
        • Madazio G
        • Moreti F
        • et al.
        Efficiency and cutoff values of self-assessment instruments on the impact of a voice problem.
        J Voice. 2016; 30: 506.e509-506.e518
        • Oğuz H
        • Kiliç MA
        • Şafak MA
        Comparison of results in two acoustic analysis programs: Praat and MDVP.
        Turkish J Med Sci. 2011; 41: 835-841
        • Hensor EM
        • Emery P
        • Bingham SJ
        • et al.
        Discrepancies in categorizing rheumatoid arthritis patients by DAS-28 (ESR) and DAS-28 (CRP): can they be reduced?.
        Rheumatology. 2010; 49: 1521-1529
        • Sengul I
        • Akcay‐Yalbuzdag S
        • Ince B
        • et al.
        Comparison of the DAS 28‐CRP and DAS 28‐ESR in patients with rheumatoid arthritis.
        Int J Rheum Dis. 2015; 18: 640-645
        • Hisli N
        Beck depresyon envanterinin universite ogrencileri icin gecerliligi, guvenilirligi. (A reliability and validity study of Beck Depression Inventory in a university student sample).
        J Psychol. 1989; 7: 3-13
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Lawrence Erlbaum Associates, New York1988
        • Gómez-Puerta JA
        • Cisternas A
        • Victoria Hernández M
        • et al.
        Laryngeal assessment by videolaryngostroboscopy in patients with rheumatoid arthritis.
        Reumatol Clín (Eng Ed). 2014; 10: 32-36
        • Kırgezen T
        • Sünter AV
        • Ö Yiğit
        • et al.
        Influence disease activity on voice and laryngeal findings of rheumatoid arthritis patients.
        J Voice. 2018; : 1-5
        • Miura Y
        • Fukuda K
        • Maeda T
        • et al.
        Gastroesophageal reflux disease in patients with rheumatoid arthritis.
        Modern Rheumatol. 2014; 24: 291-295
        • Gorham-Rowan MM
        • Laures-Gore J.
        Acoustic-perceptual correlates of voice quality in elderly men and women.
        J Commun Disord. 2006; 39: 171-184
        • Gregory ND
        • Chandran S
        • Lurie D
        • et al.
        Voice disorders in the elderly.
        J Voice. 2012; 26: 254-258
        • Liu ZW
        • Masterson LM
        • Srouji IA
        • et al.
        Voice symptoms in patients with autoimmune disease: a cross-sectional epidemiological study.
        Otolaryngol Head Neck Surg. 2012; 147: 1108-1113
        • Speyer R
        • Speyer I
        • Heijnen MA
        Prevalence and relative risk of dysphonia in rheumatoid arthritis.
        J Voice. 2008; 22: 232-237
        • Kosztyla-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
        • Berjawi G
        • Uthman I
        • Mahfoud L
        • et al.
        Cricothyroid joint abnormalities in patients with rheumatoid arthritis.
        J Voice. 2010; 24: 732-737
        • Akkoç N.
        The epidemiology of rheumatic diseases in Turkey and its comparison to other countries.
        RAED Dergisi. 2010; 2: 1-8
        • Hagen P
        • Lyons GD
        • Nuss DW
        Dysphonia in the elderly: diagnosis and management of age-related voice changes.
        South Med J. 1996; 89: 204-207
        • Boone DR
        • McFarlane SC
        • Von Berg SL
        • et al.
        The Voice and Voice Therapy.
        7th Edition ed. Pearson, Boston2005
        • Ogut F
        • Midilli R
        • Oder G
        • et al.
        Laryngeal findings and voice quality in Sjögren's syndrome.
        Auris Nasus Larynx. 2005; 32: 375-380
        • Klingholz F
        • Martin F.
        Quantitative spectral evaluation of shimmer and jitter.
        J Speech Lang Hear Res. 1985; 28: 169-174
        • Liberman AM
        • Harris KS
        • Kinney JA
        • et al.
        The discrimination of relative onset-time of the components of certain speech and nonspeech patterns.
        J Exp Psychol. 1961; 61: 379-388
        • House A
        • Andrews HB.
        The psychiatric and social characteristics of patients with functional dysphonia.
        J Psychosom Res. 1987; 31: 483-490
        • Willinger U
        • Völkl-Kernstock S
        • Aschauer HN
        Marked depression and anxiety in patients with functional dysphonia.
        Psychiatry Res. 2005; 134: 85-91
        • Dickens C
        • McGowan L
        • Clark-Carter D
        • et al.
        Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis.
        Psychosom Med. 2002; 64: 52-60
        • Isik A
        • Koca SS
        • Ozturk A
        • et al.
        Anxiety and depression in patients with rheumatoid arthritis.
        Clin Rheumatol. 2007; 26: 872-878
        • Matcham F
        • Rayner L
        • Steer S
        • et al.
        The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis.
        Rheumatology. 2013; 52: 2136-2148