Difficult intubation of an RA patient is due to what?

• A. Cricoarytenoid arthritis
• B. Atlantoaxial subluxation
• C. Mandibular hypoplasia
• D. Laryngeal edema

Answer: (A)

When rheumatoid arthritis involves the laryngeal joints, it most directly affects the cricoarytenoid joints, which control vocal cord movement. Inflammation and possible fixation of these joints reduce the ability of the vocal cords to abduct and adduct, narrowing the glottic opening and making laryngoscopy and passage of the endotracheal tube more difficult. The resulting restricted airway patency and less mobile cords explain why intubation can be challenging in RA patients. While cervical spine instability from atlantoaxial subluxation is an important airway risk in RA, it contributes more to the need for careful neck handling than to the difficulty of getting the tube through the cords itself. So cricoarytenoid arthritis best explains the difficult intubation in this context. Plan accordingly with airway preparedness, considering awake fiberoptic or video-assisted techniques and having a backup airway option.