Background Rheumatoid arthritis (RA) may lead to voice impairment through several anatomical and functional alterations.
Objectives To evaluate the prevalence of voice impairment in RA patients and to determine the correlation with disease activity and impact on quality of life.
Methods One hundred and sixteen consecutive RA patients (98 females, 18 males), mean age 54.9 years and mean disease duration 11.5 years attending routine rheumatology outpatient clinics were assessed for current RA activity by disease activity score 28 (DAS28), functional status by health assessment questionnaire disability index (HAQ-DI) and completed the Voice Handicap Index-10 (VHI-10). The inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed. High resolution computed tomography (HRCT) was performed to assess the cricoarytenoid joint (CTJ). Vocal symptoms such as hoarseness, loss of range and vocal fatigue were assessed. A control group age-sex matched individuals with no voice or autoimmune abnormalities was included.
Results The prevalence of voice symptoms amongst RA patients was 31% compared to 5% in the control group, p < 0.01. RA patients had significantly higher VHI-10 scores compared to controls, p< 0.05. A significant correlation was noted between VHI-10 scores and DAS scores and HAQ-DI scores respectively. The inflammatory markers ESR and CRP were significantly higher in patients compared to controls. Furthermore, a significant correlation was noted between disease duration and VHI-10 scores (r = 0.578; p< 0.01). HRCT showed significant affection of the CTJ in patients; with 54% demonstrating narrowing of the joint and 37% had increase in CTJ density.
Conclusions The findings demonstrate an increased prevalence of voice impairment in RA patients. Voice impairment correlated with disease activity, functional disability and inflammation. The implication of the findings of the present study is that voice impairment is an often overlooked problem. Health care professionals should be vigilant about assessing for voice impairment as in addition to impairing quality of life, voice impairment may well be a marker of disease activity.
Disclosure of Interest None Declared
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