The prevalence of dysphonia, its association with immunomediated diseases and correlation with biochemical markers

Abstract

Introduction: Patients with autoimmune diseases may suffer from hoarseness and voice disorders because of anatomical and functional alterations.

Objectives: To assess the prevalence of dysphonia in rheumatic patients and its impact on their quality of life (QOL). To analyze the association of voice disorders in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren syndrome (SS). To determine if voice disorders during the acute phase of these diseases are correlated with specific biochemical parameters.

Methods: Present an observational and transverse analytic study of 140 patients selected from February 2009 to January 2010. The subjects (80) were diagnosed with RA (44), SLE (32), and SS (4), and the control group (60) presented no voice disorders or rheumatic diseases. Patients were evaluated using the Voice Handicap Index (VHI) and a three items outcome scale (TIOS). A biochemical and C-reactive protein study was performed on 40 patients with a disease outbreak, measuring their complement, sedimentation velocity (VSG), and anti-DNA antibodies.

Results: The prevalence of dysphonia among the subjects was 32-38% as opposed to 5-8% in the control group. The rheumatic patients presented an odds ratio (OR) for dysphonia of 2.82 (VHI) and 5.04 (TIOS) when compared with healthy individuals (P<0.05). We found statistically significant differences in functional, physical, occupational, and emotional subscales of these tests. No significant differences were found when studying the biochemical parameters. A higher incidence of voice disorders (OR=3.07) was associated with SLE, followed by RA (OR=2.8; 95% CI).

Conclusions: Systemic immunomediated diseases may associate voice disorders. Patients with SLE are those who develop these disorders more frequently. The biochemical parameters most affected during a crisis are VSG and anti-DNA antibodies.