AIRWAY IMPLICATIONS OF CRICOARYTENOID ARTHRITIS: A REPORT AND REVIEW OF THE LITERATURE

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Fellow Case Reports INTRODUCTION: While the colloquial airway consideration in rheumatoid arthritis (RA) patients is cervical instability, cricoarytenoid joint (CJ) involvement present up to 70% (1). We a case 64-year-old gentleman who presented extremis with stridor and hypoxemia setting known advanced required fiberoptic intubation via bronchoscope. CASE PRESENTATION: The patient was RA, RA-associated interstitial lung disease, CJ bilateral vocal fold hypomobility. had previously received corticosteroid injection into his CJs nodule posterior aspect right membranous cord by otolaryngology earlier year.On evaluation, dyspneic, hypoxemic 70%, audible improvement saturations 100% on NRB mask. He given IV corticosteroids, racemic epinephrine, albuterol without improvement. also placed non-invasive positive pressure ventilation for acute respiratory acidosis. decision made intubate. Video laryngoscopy ED reported cords paralyzed closed position. Due failed laryngoscopy, awake, minimal sedation planned. 6.0 ETT over bronchoscope introduced oropharynx after topicalization 20% cetacaine spray. Vocal were bulky immobile opening <1mm expiration (Figure 1). abnormal appearing revealed small inferior along corniculate cartilage. Cords passed atraumatically tube trachea. Primary carina visualized inserted level ~3cm above. DISCUSSION: Rheumatoid chronic inflammatory disease number systemic manifestations. common atlanto-axial subluxation hyperextension during another typical feature incidences as high (1,2). Despite this prevalence, it appears that onset relatively rare. It later course often precipitant inflammation When approaching these patients, may be prudent 1. prepare early surgical if needed, 2. strongly consider bronchoscopic intubation. This approach minimizes neck extension while concomitantly allowing minimally invasive inspection cords. CONCLUSIONS: In arthritis, should considered preparations difficult routinely made. highlights life-threatening potential CA one securing patients. REFERENCE #1: Pradhan P, Bhardwaj A, Venkatachalam VP. Bilateral arthritis: cause recurrent upper obstruction arthritis. Malays J Med Sci. 2016;23(3):89-91. #2: Charlin B, Brazeau-Lamontagne L, Levesque RY, Lussier A. Cricoarytenoiditis comparison fibrolaryngoscopic resolution computerized tomographic findings. Otolaryngol. 1985;14(6):381-386. #3: Manczak M, Gasik R. Cervical spine instability - imaging methods. Reumatologia. 2017;55(4):201-207. DISCLOSURES: No relevant relationships Olumayowa Abe, source=Admin input, value=Honoraria Removed 07/15/2021 Abie Gregorash Christian Castaneda, source=Web Response Christina Jee Ah Rhee,