Rheumatoid Arthritis Nodule

Weekly Teaching Tip – August 18, 2014
by Dr. Curt Stock and Anna Siciliano

An Unusual Case of Dysphonia

We often see rather interesting cases of dysphonia in the Voice and Swallowing Center in Salt Lake City, Utah.  My colleague referred a lady in her 50’s with persistent hoarseness of several months duration to the clinic for further flexible fiber optic and stroboscopic evaluation.  Her only real significant past medical history was that of Rheumatoid Arthritis. Her only medications were for her RA. These did not include Methotrexate or Embril, but only medications for symptomatic treatment. We present a case of a Rheumatoid nodule of the vocal fold.

Rheumatoid Arthritis or RA affects about 3% of the population and in all cases about 1/3 of patients have laryngeal symptoms. It is an Autoimmune disease with presenting symptoms of morning stiffness lasting for over one hour, joint pain, joint swelling, weakness and fatigue. (Well that may describe a lot of us over 60). Most frequent presenting laryngeal symptoms are foreign body sensation in the throat, and vocal weakness. In 66% of laryngeal involvement the cricoarytenoid joint is involved inhibiting the movement of the vocal folds. Then we have rheumatoid nodules, frequently called “Bamboo nodules” from their pathological appear microscopically.

These nodules are treated with conventional RA medications and even steroid injections into the nodules themselves.

The attached video shows a subtle submucosal nodule in the body of the left vocal fold and not on the edge as one would expect the typical “Screamers Nodule”.

Anyhow, just another nugget as you teach your students and perhaps one day come across persistent hoarseness in a patient with Rheumatoid Arthritis.

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