Some patients with rheumatoid arthritis will have laryngeal disease that can result in upper airway obstruction. In these patients it may be difficult to manage the airway during and after surgery.


Causes of upper airway obstruction:

(1) cricoarytenoid arthritis with adduction of the vocal cords

(2) laryngeal edema following intubation


Clinical findings in a patient at risk:

(1) laryngeal pain

(2) hoarseness

(3) dysphagia

(4) dyspnea during exercise


Pulmonary function test findings:

(1) reduced maximal breathing capacity

(2) reduced peak inspiratory flow rate

(3) reduced peak expiratory flow rate


Followup may include:

(1) measurement of the flow volume loop (which will indicate upper airway obstruction)

(2) fiberoptic nasopharyngoscopy by an otolaryngologist


Additional factors that may affect the ability to maintain the airway:

(1) micrognathia

(2) temporomendibular joint arthritis

(3) tongue-related airway obstruction


A patient with evidence of laryngeal disease prior to surgery may benefit from an elective tracheostomy prior to surgery.


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