Until 1955 a few reports had been made concerning this problem. On December
1955. Montgomery, Perone and Schall reported
four cases of rheumatoid arthritis of cricoarytenoid joint. It seemed to have interested other authors so that Saunders, Pearson, BakerBywaters, Copeman and Polisar reported their clinical findings. In 1957 Pearson presented a histological section
of cricoarytenoid joint, showing villous synovial
proliferation. In 1959 Montgomery reported
another series of additional cases and microscopical findings of the cricoarytenoid joint of two patients with rheumatoid arthritis. This study did not show a complete fibrous ankylosis but severe arthritic changes were seen. In the same year Copeman et al. reported an autopsy case of rheumatoid arthritis with ankylosis of cricoarytenoid joint. In early 1960's Grossman et al. examined 55 patients with rheumatoid arthritis and found 18 patients with some suggestive evidence of cricoarytenoid arthritis. Lofgren and Montgomery examined 100 patients of rheumatoid arthritis, finding 26% of them had involvement of cricoarytenoid joint. They stated that this disease seemed to be more common and more severe in female. Bienenstock stated 17 cases of 64 randomly selected patients with rheumatoid arthritis had one or more symptoms considered to be characteristic of cricoarytenoid arthritis. He claimed that arthritis of cricoarytenoid joint occured much more frequently in patients with rheumatoid
arthritis than had been suspected. At postmortem examination Grossman saw histological changes of cricoarytenoid joint characteristics of rheumatoid arthritis in 5 of 11 autopsied patients with rheumatoid arthritis and Bienenstock found the same in 7 of 8 patients. In
1963 for the third time Montgomery discussed of
cricoarytenoid arthritis, based on his own
experiences and many available literatures.
Pathologic changes range between the mere
synovial thickning and the complete disruption.
Montgomery believed as others did, that in
ankylosing chronic stage inspiratory bowing of
both vocal cords and absolute fixation of arytenoid cartilage were diagnostic signs of rheumatoid arthritis of cricoarytenoid joint.
In 1958 Darke, Wolman and Young reported five
cases of laryngeal stridor, where in four cases
tracheotomy became necessary. Two of them
were brought to autopsy and histological examination. They found evidence of the nerve
degeneration and mobile cricoarytenoid joint.
The cause of nerve degeneration in the second
case was an ischaemic neuropathy from rheumatoid
arteritis of vasa nervorum. These findings
were different from those of Montgomery and
others. In 1965 Wolman, Darke and Young had an
opportunity of six more autopsy examples. They
confirmed from their own pathologic findings that
laryngeal stridor occuring in rheumatoid
arthritis was due mainly to arteritis of the vasa
nervorum causing ischaemic neuropathy and that
polymyositis and joint disease might augment
this effect. Woldorf and Webb et aI. introduced
both of these opinions. Anyhow, in U. S. A. and in England 25%-28% of rheumatoid arthritis seems to have rheumatoid arthritis of cricoarytenoid joint. On the other hand in our country there has been seen no report on rheumatoid arthritis of cricoarytenoid joint. In order, therefore, to investigate this problem author examined in medical clinic of Misasa branch hospital of Okayama university school of medicine 76 patients of classical and definite rheumatoid arthritis. Their complaints were as follows.
1) dryfeeling of throat 17 (22.4%) 2) slight hoarseness 11 (14.5%) 3) choking by long conversation 1 (1.32%) 4) slight dysphagia 2 (2.6%) The larynx was mirrored indirectly by Türk's, Killian's and Avellis's position. Any redness, swelling of mucous membrane, abnormality of vocal cords and arytenoid cartilage were not found.