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

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.