Laryngeal involvement in rheumatoid arthritis.

Patient with rheumatoid arthritis should be screened prior to surgery for any laryngeal manifestation. A thorough history and physical examination coupled with indirect or direct laryngoscopy are mandatory. Nonspecific laryngeal symptoms in patients with rheumatoid arthritis should raise suspicion of laryngeal involvement. Phonatory disturbances or airway difficulties may reflect advanced stages of the disease. Their presence is usually coupled with high resolution computerized tomography findings. Aggressive therapy should be started and corticosteroid injection should be contemplated in cases of failure of conventional treatment. The anesthesiologist should handle with extreme care the inflamed laryngeal structures and be least aggressive in securing the airway.