SHM Converge Scientific Abstract ePoster Gallery-Subglottic Stenosis as the Initial Manifestation of Rheumatoid Arthritis

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This case highlights subglottic stenosis (SGS) as an unusual initial manifestation of rheumatoid arthritis (RA). A 50-year-old woman with hypertension repeatedly presented over one year with cough, wheezing, and exertional dyspnea and was treated as having asthma. On her sixth visit, she developed progressive throat tightness and hoarseness. Examination revealed biphasic stridor, suggesting upper airway obstruction rather than lower airway disease.<br /><br />Non-contrast CT of the neck showed eccentric subglottic narrowing, and flexible laryngoscopy demonstrated about 75% airway obstruction with mobile vocal cords. Bronchoscopy confirmed severe SGS. She underwent endoscopic coblation excision, intralesional triamcinolone injection, and balloon dilation. Biopsy showed chronic inflammatory changes without malignancy.<br /><br />Because SGS can be associated with autoimmune disease, serologic testing was performed. Rheumatoid factor was markedly elevated, and anti-CCP antibodies were strongly positive, supporting early RA despite the lack of prominent joint symptoms. After excluding other causes, she was diagnosed with RA-associated SGS and started on methotrexate. Follow-up laryngoscopy showed sustained airway patency without restenosis.<br /><br />The key lesson is that RA can involve the airway, though this is rare and usually presents as cricoarytenoid arthritis. SGS is an uncommon extra-articular manifestation that may occur before typical joint disease and is frequently mistaken for asthma. Persistent wheezing or dyspnea that does not respond to bronchodilators should prompt evaluation for fixed upper airway obstruction with laryngoscopy, imaging, and autoimmune workup. Management generally combines endoscopic airway intervention with corticosteroids and systemic immunosuppression to reduce recurrence.

Asset Subtitle

Harleen K. Sidhu

Meta Tag

Author List Adithan Ganesh, Harleen K. Sidhu, Oikigbeme Oikeh, Umaima Dhamrah

Category Clinical Vignettes

Concept Rheumatoid Arthritis

Concept Subglottic Stenosis

Concept Upper Airway Obstruction

Concept Asthma

Concept Stridor

Distinguished Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Harleen K. Sidhu

Track Adult

Keywords

subglottic stenosis

rheumatoid arthritis

upper airway obstruction

biphasic stridor

asthma misdiagnosis

flexible laryngoscopy

bronchoscopy

anti-CCP antibodies

methotrexate

endoscopic dilation

Rheumatoid Arthritis

Subglottic Stenosis

Upper Airway Obstruction

Asthma

Stridor