FIGURE 1 Glottic and subglottic stenosis in a patient with Wegeners granulomatosis

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arthritis may also occur in patients with other rheumatoid diseases such as Sjogren's syndrome or systemic lupus erythematosus (SLE). Laryngoscopy in cricoarytenoid arthritis reveals inflammation of the overlying mucosa and limited vocal-fold mobility. Diagnosis is established by palpation during direct laryngoscopy, which can demonstrate mechanical restriction of joint motion. Computed tomography (CT) imaging often demonstrates erosion of the cricoarytenoid joint, with surrounding soft-tissue edema. Cricoarytenoid arthritis may be asymptomatic because many RA patients have cricoarytenoid joint abnormalities on CT but no laryngeal problems (2). Tracheotomy is often required for acute airway obstruction; however, cricoarytenoid arthritis usually responds dramatically to steroid treatment.

A less common laryngeal manifestation is the rheumatoid nodule: a focal submucosal inflammatory infiltrate on the membranous vocal fold (Fig. 2). Rheumatoid nodules are characteristically seen as subcutaneous lesions in other parts of the body in 20% of patients. They occur on the vibratory edge of the vocal fold and can cause significant hoarseness (3). Simple endoscopic excision is effective, but recurrence has been reported (4).

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