A Hoarse of a Different Color

About three years ago my voice started getting hoarse now and then. I’d be talking to someone, just minding my own beeswax and boom—suddenly I was croaking. It felt like there was something small or granular stuck in there. So, I’d clear my throat. It didn’t help. I’d clear it again, still to no avail. So, since I didn’t have a choice, I’d just rasp and buzz along like nothing was wrong, hoping that my companion wouldn’t notice.

People are nice. No one ever says anything about my suddenly scratchy voice.

When it first started, I thought maybe I was catching a cold. But my throat never got sore, and the cold that I was sure was about to bowl me over never did. Instead, the hoarseness would just go away, sometimes as suddenly as it started, and usually within 24 hours. I’ve had a grass allergy since I was a young adult, but hoarseness has never been one of the symptoms. I was baffled as to what might be causing it, but since it didn’t stick around for long each time, didn’t hurt, and didn’t really cause me any trouble, I didn’t worry about it. Much.

And then one day, as I was doing some research for an article I was writing about rheumatoid arthritis, I stumbled across the explanation. There’s a joint in the throat. It’s called the cricoarytenoid joint (CAJ), and it’s located near the vocal cords.

I know. I was as surprised as you are.


Why in the world would we need a joint in our throats? There are no miniature arms, legs, shoulders, wrists, fingers, or feet in there. But it turns out that we need that tiny joint, just the same. It sits between the cricoid and arytenoid cartilages at the back of the larynx, or windpipe. When we speak, the vocal cords vibrate and rotate the CAJ, changing the tone of the voice.

As you know, in rheumatoid arthritis, the body’s immune system attacks the synovial and other soft and connective tissues around and in the joint. It causes inflammation—rheumatoid synovitis—that makes the joint stiff and hinders its movement.

The same thing happens to the CAJ. Inflammation caused by RA stiffens it and prevents it from moving correctly. The most frequent result is a hoarse voice—and that hoarseness is something that about half of those with RA have.

There are other symptoms, as well. They include a sense of fullness in the throat (bingo!), pain in the ears, shortness of breath, stridor (noisy breathing), pain when speaking or swallowing, and loss of voice. Symptoms can become so severe they require an emergency tracheotomy. Fortunately, this is very, very rare.

Cricoarytenoid arthritis can be difficult for doctors to diagnose. Its symptoms are similar to those of allergies, acid reflux, asthma, and to some cancers, to name just a few. Like me, most people with RA would never dream that their hoarse, scratchy, sometimes weak voice could be caused by their disease attacking yet another joint. A miniscule one in their voice box.

RA can also attack the cricothyroid joint. When it does, it causes a limited vocal range, along with hoarseness. Finally, RA nodules can form on the back of the vocal folds, messing with the voice and even the breathing.

Ahem. There is just no end to the surprises RA has in store for us. Who’d have thunk it?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (24)
  • Debbiesue1008
    12 months ago

    Oh one more note…I now have raynaud’s that is something I never had before. I had to prove it to them by taking pictures and I know this can also be a part of the cluster for RA.

  • Jill Fontana-Langthorne
    2 years ago

    I’m so glad I found this article. Right now, I’m having issues with this. I am hoarse, feel like I have a lump in my throat, and pain in my ears. I brought an article too my old rheumatologist few years back and he practically brushed me off but knowing my body I knew what was going on! He of course said it could be, but to know you have to look down your throat… Well?? Nothing.,,, I have an appointment with my new rheumy this week, so I will talk to her and hopefully I won’t get the brush off! Thanks again and wish you good health!

    Jill

  • Erin Rush moderator
    2 years ago

    We’re glad this article was helpful for you, Jill. I hope your appointment with your new rheumatologist goes well and you get some helpful answers! Good luck and feel free to update us on how your appointment goes, if you feel comfortable doing so. Best, Erin, RheumatoidArthritis.net Team Member.

  • agsides
    3 years ago

    Can anyone offer more information on breathing issues with RA?

    I’ve totally lost my voice, breathless, and my chest aches on deep breathes thanks to mild coughing. I’ve had a tightness in my chest for months but it was blamed on the black mold I found in my rental house, I’ve since moved out and the breathing issues have turned into asthma like symptoms with me reacting to any trigger, smoke, perfume, ect. This week I’ve been mostly mute for several days but no throat pain.

    I’ve been to my GP, an allergist, and see my Rheumatologist in two weeks but so far all my test results are normal. I had swollen lymph nodes and low grade fever so was put on antibiotic, low dose prednisone, and given an inhaler. Even with all that I’m still mute and breathless.

  • Erin Rush moderator
    3 years ago

    Hi agsides. I am so sorry you are dealing with continued breathing and voice issues. You are doing the best thing possible right now — getting this checked out by your physicians! That is by far, the best thing to do when you have new or worsening symptoms. I am sorry that they have been unable to offer you any answers at this time. While we cannot offer medical advice, for your safety, I will state that the effects of black mold exposure can potentially linger for months, possibly years. I would be interested to see what your rheumatologist finds. It does sound like your body is having both an allergic and immune system response to *something*. You state that you are having asthma-like symptoms; have any of the physicians diagnosed you with asthma or any other breathing issues? I would be curious to know what tests they have run. This is definitely something that should be dealt with. Don’t hesitate to be a “squeaky wheel” with your physicians if your symptoms don’t improve. Here is some information on lung issues people with RA may deal with — https://rheumatoidarthritis.net/symptoms/lung-diseases-and-conditions/. I hope this helps! Please keep us posted on hoe you are doing and on your upcoming rheumatologist appointment, if you feel comfortable sharing with us. Thank you for sharing! Best, Erin, RheumatoidArthritis.net Team Member.

  • Sherilyn Grady
    4 years ago

    I also want to thank you for this article! I thought it was allergies, even though I didn’t always have other allergy symptoms. But I also experienced a tightening in my throat that sometimes would affect swallowing. My Family Doctor said blood test were fine as far as the thyroid is concerned and just it could be the allergies. It makes sense now. I sometimes have problems in my jaw and figured the ear pain stems from that. Thanks for all the info!!

  • Wren moderator author
    4 years ago

    Hi, Sherilyn,
    Like you, I thought my occasional hoarseness might be from allergies. And who knows, maybe sometimes it is. But when there are no other allergy symptoms, then CAJ comes to the forefront as a cause. I’m glad reading the article helped you make sense of your scratchy voice.

    RA also affects the jaw–the temporomandibular joint–and there is a miniscule joint in the ear that can be affected, as well. I plan to write about those in the future.

    Thanks for stopping by and taking the time to comment! It’s great to hear from you. 😀

  • marcia ewell
    4 years ago

    Thanks for the great info. I also have lost my voice for 3-4 months during the first few years of my RA being diagnosed when it floated around my body and effected every system in my body. I went thru all sorts of tests and eventually ended up at the ENT office where they looked down my throat with a camera. My vocal cords were covered with a mass of nodules which were limiting my vocal cords ability to vibrate properly. The frustrating part was the specialized ENT doctor had never heard of RA effecting the voice box joint since doctors can go thru med school without even a hint of training in Rheumatology. The doctor did not want to believe RA could effect the voice box and even got defensive when I suggested it was RA nodules he was looking at. I tried to educate him some and tell him the nodules were in my lungs and all over my body, but he had an attitude and did not want to acknowledge the possibility of RA nodules affecting my voice. I did some voice PT and whispered for another couple of months and finally I got my voice back.

  • Wren moderator author
    4 years ago

    Hi, Marcia! I guess your bad experience with that ENT proves that doctors aren’t immune to donkey-tush disease…

    I’m sorry you had to suffer through that for so long, only to run up against such a silly wall of ignorance. But I’m glad it wasn’t permanent, and that things didn’t get even worse. When I was researching the article, I read one paper that talked about a person with cricoarytenoid arthritis having to have a tracheotomy. NOT good!

    I hope that was the end of your experience with voicebox arthritis. And I hope that your RA is currently being treated and under control, so that you’re feeling strong and well. Thank you for commenting. Stop by again soon! :o)

  • Kathy P.
    4 years ago

    Thank you for that interesting article, and it explains so much! I’ll also have to see if hoarseness is a precursor to a bad flare.

    Carolyn, I’ve had Graves Disease (hyperthyroidism), which was ablated, and now am kept at a subclinical state of hypothyroidism because of the problems caused with my heart when I was hyperthyroid. It’s usually an easy job for your general practitioner doctor to check for either hyper or hypothyroidism with a simple blood test, examination and manual palpation. When I was severely hyper and hypo, I did have problems with my voice, but there were many other symptoms that were more of a problem and very serious.

    I’d say to print out this article, take it with you to your rheumatologist and have a discussion. The rheumatologist will help you to figure out if it’s due to RA or your thyroid.

    Good luck!

  • Wren moderator author
    4 years ago

    Hi, Kathy! I’m glad you found the article interesting and helpful. And thanks so much for offering further information to Carolyn. Having an active, caring community like this one at RheumatoidArthritis.net is vital–and uplifting. It’s good to support one another.

    Thanks for your comment. I hope to hear from you again. 🙂

  • Carolyn Haney
    4 years ago

    Thank you for writing about this problem of hoarseness, I’ve never even tried smoking so this was an “Aahaa” moment for me. I’ve often worried that because I also have hypothyroidism the problem with my throat might be thyroid cancer

  • Wren moderator author
    4 years ago

    Hi, Carolyn! It’s comforting to know–or at least, to have a possible explanation–for what’s causing odd symptoms, like hoarseness. Only your doc can tell you for sure, however. You asked for some more in-depth info, so I’ve a couple of online sources you can check:

    http://rheumatology.oxfordjournals.org/content/40/5/593.full.pdf+html

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707215/#__ffn_sectitle

    If you google “cricoarytenoid joint” you’ll find many more. I’ve found that these “ahah” moments happen more and more often as I learn more about this disease. It’s always a surprise.

    Thanks so much for reading and taking the time to comment. 🙂

  • Carolyn Haney
    4 years ago

    Can you share some more indept information about “Hoarseness” if it’s available.
    Thank you,
    Carolyn H

  • Christy Caraway
    4 years ago

    Thank you so much. There really is no end to what I learn about this horrible disease. I have been suffering from this for so long. I am 42 & was diagnosed about a year ago with severe RA & honestly I’m not dealing with it well. But it helps to see I’m not just going crazy it is this horrible disease. Thank you for sharing.

  • Wren moderator author
    4 years ago

    I’m so sorry that you’re having a tough time dealing with your RD, Christy. Please know that you’re absolutely not alone, and that there are many, many of us who care about how you’re feeling. I’m glad you stopped by here at RheumatoidArthritis.net, because I honestly believe you’ll learn more about this disease here than you will at most other websites. The information you’ll read here is sound and down-to-earth, and you’ll find stories from lots of others who’re fighting RD right along with you.

    I hope you’re seeing a rheumatologist. Be patient; the meds for RD work/don’t work differently for each of us, and it can take some time before you find one that can provide you with some relief from pain and that will slow down the progression of the disease.

    Take good care of yourself. Thanks for your comment. I’m sending you a warm hug and best wishes. 🙂

  • Jenny
    4 years ago

    I will turn 28 next month and was recently diagnosed with RA. I have had severe pain for many years, but it wasn’t until I had been suffering from the morning stiffness and inflammation in my joints that my PCP referred me to a rheumatologist. The hoarseness in my voice was something I didn’t know about though! It’s been happening on and off for a little while, but I assumed it was a result of cigarette smoking (I just recently quit). This makes so much sense! It’s actually been happening the past few days and today I awoke in more pain than normal, from what I assume is a flare up, and the pain has only gotten worse as the day has gone on rather than getting better as it normally does. I am so glad I saw this article and am now able to link the symptom to my RA and will maybe be better able to predict my flare ups! Thank you!

  • Wren moderator author
    4 years ago

    Hi, Jenny! You know, there are so many “ahah!” moments with this disease! Like you, it didn’t occur to me that my occasional hoarseness might be heralding an oncoming flare before reading Michelle’s comment (below), but I’ll be paying more attention from now on.

    Like you, I thought my hoarseness might be from smoking (I stopped a few years ago), but I think if that was it I’d be hoarse more often than I am. That it could be CAJ just seems much more likely.

    Glad to hear that you’ve finally gotten a diagnosis and can now get some effective treatment for your disease. Thanks so much for stopping by, and for taking the time to comment. I hope we’ll hear from you again soon. 😀

  • jan curtice
    4 years ago

    Thank you for writing about this topic. This is a problem I’ve been struggling with for the last 1.5 years. I’ve been to see my PCP, rheumatologist, pulmonologist, ENT, neurologist, and gastroenterologist. After all kinds of tests and a biopsy, the answer was my rheumatoid arthritis is affecting the cricoarytenoid joint. So far, treatment has not helped me. I’ve had to adapt with eating a soft diet because I am unable to swallow anything of much substance. There is also a feeling of isolation that comes from being “speechless” and unable to talk. Usually, I have some voice (hoarse whisper) in the morning but it is gone by lunch. The most difficult challenge has been not being able to talk to my family, especially those who do not live nearby. RA is a thief. BUT I continue to seek out ways to not let it define who/what I am. I’m going to talk to my rheumatologist about Eleanor’s experience. One thing I do know, that for every problem, God gives an answer … some we have to dig a little deeper for.

  • Wren moderator author
    4 years ago

    Hi, Jan! I’m delighted that reading my story about CAJ, and the comments readers have left about it, have given you something you can take to your rheumatologist that might solve the problem you’re having with your throat. It makes taking the time to research and write so worthwhile!

    It must be really hard for you, not being able to speak well or eat normally because of this. I hope your doctor will be able to help, and soon.

    Thanks for stopping by, and for taking the time to comment! 😀

  • ELEANOR TUPPER
    4 years ago

    i actually suffered from a rhumatoid nodule on my right vocal cord,went to ENT specalist was given steroid inhalers, didnt work,my specalist sent me to a voice dr in a near by town.there are only 2 such drs.with this specialty in the entire state.he had to use a long device that he threaded down my nostral ,down my throat to the vocal nodule.then he gave me a steroid injection directly to that area.he had first taken a small camera that he viewed on a large tv like screen to know exactly where to place the injection[it was on a long tube that fit threw my nostral also] luckily it did not hurt too much. i had to go back to him at monthly visits to get that shot 3 more times.it worked and i no longer have any vocal etc. problems. i was so very thankful that this was available to me.just wanted to share my experience with rhumatoid arthritis.my local RA dr.couldnt do anyting for this problem.i would never beleived a hoarse voice would end up the way it did.

  • Wren moderator author
    4 years ago

    Wow, Eleanor! That’s amazing! You were lucky there was a specialist who could treat this condition that lived nearby–and that you were able to figure out what the problem was in the first place. I think you were incredibly brave, getting an injection inside your throat–it sounds awful, but I believe you when you say it wasn’t too bad.

    So glad you no longer have to deal with this. Thank you so much for stopping by and commenting–you’re helping others who may run into this problem themselves someday, and educating all of us. 😀

  • Michelle
    4 years ago

    When I first presented with sympotoms it took forever to diagnose me because my body went all wacky, including my voice. I saw a gastroenterologist and was scoped, monitored and given reflux medicine…come to find out this swelling in the CAJ was the culprit, not reflux. Years later, pretty well controlled on meds and now this CAJ business is one of the first things that happens when I go into a flare…nice little warning sign, eh? My Rheumy told me that 5% of RA patients will experience this. Lucky us, ha!

  • Wren moderator author
    4 years ago

    Hi, Michelle. I’m glad they finally figured out that it was the CAJ causing your hoarseness, not GERD. RD is such a strange disease; I’m always learning something new about it.

    You know, I’ve never connected my periods of hoarseness to flares, but now you’ve brought it up, I think I’ll start paying more attention. Lucky us, indeed!

    I’m delighted you stopped in and commented. Please come back soon! 🙂

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