慢性関節リウマチの耳科･咽喉科領域における障害について 第2報 : 慢性関節リウマチ患者の喉頭所見について

Until 1955 a few reports had been made concerning this problem. On December 1955. Montgomery, Perone and Schall reported four cases of rheumatoid arthritis of cricoarytenoid joint. It seemed to have interested other authors so that Saunders, Pearson, BakerBywaters, Copeman and Polisar reported their clinical findings. In 1957 Pearson presented a histological section of cricoarytenoid joint, showing villous synovial proliferation. In 1959 Montgomery reported another series of additional cases and microscopical findings of the cricoarytenoid joint of two patients with rheumatoid arthritis. This study did not show a complete fibrous ankylosis but severe arthritic changes were seen. In the same year Copeman et al. reported an autopsy case of rheumatoid arthritis with ankylosis of cricoarytenoid joint. In early 1960's Grossman et al. examined 55 patients with rheumatoid arthritis and found 18 patients with some suggestive evidence of cricoarytenoid arthritis. Lofgren and Montgomery examined 100 patients of rheumatoid arthritis, finding 26% of them had involvement of cricoarytenoid joint. They stated that this disease seemed to be more common and more severe in female. Bienenstock stated 17 cases of 64 randomly selected patients with rheumatoid arthritis had one or more symptoms considered to be characteristic of cricoarytenoid arthritis. He claimed that arthritis of cricoarytenoid joint occured much more frequently in patients with rheumatoid arthritis than had been suspected. At postmortem examination Grossman saw histological changes of cricoarytenoid joint characteristics of rheumatoid arthritis in 5 of 11 autopsied patients with rheumatoid arthritis and Bienenstock found the same in 7 of 8 patients. In 1963 for the third time Montgomery discussed of cricoarytenoid arthritis, based on his own experiences and many available literatures. Pathologic changes range between the mere synovial thickning and the complete disruption. Montgomery believed as others did, that in ankylosing chronic stage inspiratory bowing of both vocal cords and absolute fixation of arytenoid cartilage were diagnostic signs of rheumatoid arthritis of cricoarytenoid joint. In 1958 Darke, Wolman and Young reported five cases of laryngeal stridor, where in four cases tracheotomy became necessary. Two of them were brought to autopsy and histological examination. They found evidence of the nerve degeneration and mobile cricoarytenoid joint. The cause of nerve degeneration in the second case was an ischaemic neuropathy from rheumatoid arteritis of vasa nervorum. These findings were different from those of Montgomery and others. In 1965 Wolman, Darke and Young had an opportunity of six more autopsy examples. They confirmed from their own pathologic findings that laryngeal stridor occuring in rheumatoid arthritis was due mainly to arteritis of the vasa nervorum causing ischaemic neuropathy and that polymyositis and joint disease might augment this effect. Woldorf and Webb et aI. introduced both of these opinions. Anyhow, in U. S. A. and in England 25%-28% of rheumatoid arthritis seems to have rheumatoid arthritis of cricoarytenoid joint. On the other hand in our country there has been seen no report on rheumatoid arthritis of cricoarytenoid joint. In order, therefore, to investigate this problem author examined in medical clinic of Misasa branch hospital of Okayama university school of medicine 76 patients of classical and definite rheumatoid arthritis. Their complaints were as follows. 1) dryfeeling of throat 17 (22.4%) 2) slight hoarseness 11 (14.5%) 3) choking by long conversation 1 (1.32%) 4) slight dysphagia 2 (2.6%) The larynx was mirrored indirectly by Türk's, Killian's and Avellis's position. Any redness, swelling of mucous membrane, abnormality of vocal cords and arytenoid cartilage were not found.

原著論文 (Original Paper)