Around 5% of patients with rheumatoid arthritis (RA) have significant voice impairment, suggest study findings published in the journal Clinical Rheumatology.
Several clinical and autopsy studies have shown that RA damages the cricoarytenoid joints that facilitate the movement and vibration of the vocal cords.
Individuals with RA can therefore develop dysphonia and hoarseness as well as chronic laryngeal dryness and vocal nodules and this can have a serious impact on a patient's confidence and emotional quality of life, say Benjamin Fisher (Charing Cross Hospital, London, UK) and co-workers.
Fisher and team noticed that, although voice impairment can seriously reduce the quality of life for those with RA, the prevalence of impairment is not known.
The researchers therefore investigated used the ten-item Voice Handicap Index (VHI-10) to assess 73 individuals with RA and 73 generally healthy volunteers all aged between approximately 54 and 60 years.
Case patients had a joint assessment, erythrocyte sedimentation rate, and their disease activity score (DAS)-28 was calculated using a visual analog scale.
"The VHI-10 is a validated, reliable and sensitive tool for investigating global voice function," say the researchers. The index consists of ten statements with a five-point scale to score agreement and is designed to quantify the sense of handicap regarding voice impairment, they explain.
Overall, 5% of those with RA were found to have significantly abnormal VHI-10 scores compared with just 1% of the volunteers who did not have RA. Furthermore, the more severe a patient's RA the more abnormal was there score.
"The 5% figure is lower than might be expected if the prevalence of cricoarytenoid arthritis was as high as recorded in previous studies," comment the investigators, who suggest that this "may be a reflection of the modern trend to suppress clinical synovitis optimally."
The authors therefore suggest a larger study "both to confirm these findings and to explore underlying causes."
Until such studies are conducted, Fisher et al recommend that clinicians "should remain aware that dysphonia may occur and may impact markedly on quality of life in those with RA."
My voice has become much weaker in the last few years and it's bothered me a great deal. It's like the sapping of my energy. I used to have a strong voice that could carry through out a room when I spoke but now its weak and breaks. I'm also hoarse quite often. I sort of blamed it on RA and age but the start of it came on quite suddenly. Interesting article. Lindy
IT makes sense because I have trouble singing anymore. I used to sing in our praise band at church and I had to stop. I have trouble swallowing all the time I thought it was because of acid reflux and also had a tumor on my thyroid which they removed the isthimus but left the nobes only to find a year later I have another nodule on right lobe. I went into surgery thinking they were removing it all also they told me it was nothing to be concerned about but when biopsy came back out of 2 opinions one said one thing one said another so Dr. questions me on why I am worried about another nodule he tells me that is is hoshimotos thyroiditis. But like you are talking about it is like always having a strain on my voice. Have a good day.I've been having trouble with my voice also. It's all quivery. I'm constantly clearing my throat to get my voice back to normal. Also my neck and throat hurt sometimes.Me too, I have no more voice strength. Everybody has been asking me to speak louder for several years now.