Background Rheumatoid arthritis (RA) is a chronic, multisystem autoimmune disease manifested by joint inflammation and damage including also joints and laryngeal cartilages which play an essential role in the process of phonation. Cricoarytenoid joint involvement may result in voice quality disorders – dysphonia.
Objectives The aim of the study was the assessment of subjective and objective parameters of voice quality in RA patients and their relationships with disease activity.
Methods The study was carried out on 62 patients with RA and 22 healthy subjects, without pathological changes of voice quality. All RA patients were evaluated by rheumatological and phoniatric examinations. Clinical examinations of RA patients included the assessment of the radiological stage according to Steinbrocker and Disease Activity Score (DAS 28). The assessment of voice quality was carried out using subjective and objective methods. The examination of the larynx was conducted by videoendoscopy (VLS) and videostroboscopy (VLSS) with the usage of videostroboscope by WOLF. Moreover, the analysis of vocal folds vibrations was also carried out using the high-speed imaging and kymography with HRES ENDOCAM 5562 system by the same company. The acoustic voice analysis based on “a” vowel and linguistic text was carried out using “DiagnoScope Specjalista” program by DiagNova Technologies. The acoustic parameters such as: F0, Jitter, Shimmer, NHR were analysed and the assessment of narrow band spectrogram was carried out.
Results Voice quality disorders with features of hypofunctional dysphonia were registered in 27 (43.5%) patients with RA. Results of the subjective assessment of voice quality were in accordance with results of the analysis of objective parameters and acoustic voice examination. In RA patients with active disease (DAS > 3.2) the laryngeal disorders of hypofunctional dysphonia were observed more frequently (57.1%) than in the group with inactive disease, in which voice pathology was found only in 15%. The impairment of vocal folds mobility was observed only in RA patients with advanced stage of the disease.
Conclusions Voice quality disorders correlated with disease activity in RA patients. The impairment of vocal fold mobility may reflect the extend of RA. Voice quality disorders in RA patients may be the result of inflammatory process as a consequence of the disease. Our findings point to an important role of the assessment of voice quality in the diagnosis procedure of RA patients. There is a need of cooperation between rheumatologists and phoniatricians in the process of treatment and rehabilitation of RA patients.
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 (2): 148-153.
Speyer R, Speyer I, Heijnen MA. Prevalence and relative risk of dysphonia in rheumatoid arthritis. J Voice 2008; 22 (2): 232-237.
Disclosure of Interest None Declared