Clinical radiology Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation Antonio Greco, MD a , Massimo Fusconi, MD a, ⁎ , Gian Franco Macri, MD a , Caterina Marinelli, MD a , Elisabetta Polettini, MD b , Anna Teresa Benincasa, MD a , Marco de Vincentiis, MD a a Department of Sensory Organs, University “Sapienza” of Rome, Italy b Emergency Radiology, University “Sapienza” of Rome, Italy Received 31 January 2012 Abstract Rheumatoid arthritis rarely involves the cricoarytenoid joint. The possible consequent symptom includes hoarseness, dysphagia, odynophagia, dysfunctional dysphonia, and acute dyspnea. Etiologic diagnosis is possible with high-resolution computed tomography, which can show spacing of the articular cartilage, density and volume alterations, and subluxation of the cartilage. However, these radiologic signs are not pathognomonic for rheumatoid arthritis, and they should be combined with anamnestic data. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Rheumatoid arthritis (RA) is a chronic systemic disease that, acting together with complex genetic and environmen- tal factors, causes inflammation and damage prevalently diarthrosis joints but may also involve extra-articular tissues and organs. The prevalence of RA ranges from 0.5% to 1.0% in many populations, and females are 1 to 3 times more likely to develop the disease than males. Peak onset of the disease is at 30 to 55 years, but it can occur at any age [1]. The disease primarily occurs in the synovial and joint tissues, with clinical features that include painful, swollen joints, and joint stiffness. Important extra-articular features include lung and cardiovascular diseases. Other organs may also be involved, and clinical features include anemia, skin nodules, neuropathies, ocular disease, splenomegaly, and vasculitis [1,2]. The cricoarytenoid joint (CAJ) of the larynx is rarely involved in RA [3]. The CAJ is a diarthrosis because it consists of a synovial membrane that surrounds an articular cavity and articular cartilaginous surfaces. An articular capsule completely surrounds the diarthrosis. During RA, the synovial membranes are thickened and are covered with “the cloth,” which is granulation tissue that develops inside the articular space and invades the articular cartilage and articular capsule. In addition, synovial liquid increases substantially, and swelling occurs, which is typically followed by the erosion of the cartilage and luxation of the joint. Laryngeal involvement in RA can be asymptomatic. Symptoms can be nonspecific, such as hoarseness, dysphagia, odynophagia, ear pain, and a sense of fullness of the throat, often during swallowing or speaking. Complications such as obstruction of the upper respiratory tract with dyspnea and inspiratory stridor are rarely observed [4,5]. Respiratory deficiency results when the inflammatory process in RA affects the CJAs [4]. Cricoarytenoid joint involvement in 17% to 70% of RA Otolaryngology cases has been reported [5]. Therefore, either acute inflammation or chronic ankylosis of the joint can impair vocal cord movement. The aim of our study is to demonstrate the utility of high- resolution computed tomographic (HRCT) scan in the diagnosis of arthritic rheumatoid lesions of CAJ. 2. Case report We present a case of a 47-year-old woman who was previously diagnosed with juvenile onset RA and active Available online at www.sciencedirect.com American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 753 – 755 www.elsevier.com/locate/amjoto ⁎ Corresponding author. Department of Sensory Organs, University “Sapienza” of Rome, Italy. E-mail address: massimo.fusconi@libero.it (M. Fusconi). 0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjoto.2012.06.004