| Abstract | Objective:
This case report aims to document and describe a presentation of cricoarytenoid arthritis, a rare secondary manifestation of ankylosing spondylitis (AS), in a 60 year-old male patient, focusing on clinical presentation, diagnostic assessments, and treatment considerations.
Methods/Design:
A comprehensive evaluation of the patient’s medical history, clinical presentation and diagnostic assessment was performed via chart review and follow-up visits. The patient has a history of severe, chronic, HLA-B27 positive AS first diagnosed in 1992, and presented to the clinic with a 6-year history of posterior neck stiffness and dysphonia. Clinical findings were obtained through physical examination, flexible videostroboscopy and computed tomography (CT) scan of the neck with contrast to assess cervical and laryngeal anatomy. Treatment options including the use of tumor necrosis factor alpha (TNF-a) inhibitor was discussed with the patient, but he declined starting this therapy.
Results/Conclusion:
The patient presented with a 6-year history of sudden-onset dysphonia secondary to left-sided vocal cord abduction paralysis, as confirmed by videostroboscopy. CT imaging showed various laryngeal abnormalities, including cricoarytenoid joint sclerosis, as well as osseous fusion of thyroid and cricoid cartilages, consistent with an extraspinal manifestation of AS. The patient did not pursue biologic treatment. The patient has been on varying doses of cyclooxygenase-2 (COX-2) inhibitor for symptomatic management. There have been no significant improvements in vocal cord mobility using conservative therapy, demonstrating the challenges in managing this rare presentation of AS. Literature supporting the successful treatment of this extraspinal manifestation of AS is limited, further demonstrating the importance of further investigative research.
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