No CrossRef data available.
Article contents
Disease activity in rheumatoid arthritis as a predictor of difficult intubation?
Published online by Cambridge University Press: 01 October 2008
Summary
Background and objectives
Rheumatoid arthritis is a lifelong systemic disease that can affect any joint with a synovium. Managing intubation in patients with rheumatoid disease is a special challenge in these patients especially if specific joints, which play an important role during intubation, are affected. We aimed to investigate if there was a correlation between the activity and duration of the disease and the commonly used predictors of difficult intubation in rheumatoid arthritis.
Methods
Sixty-six patients with the diagnosis of rheumatoid arthritis and 60 control patients were included in the study. Patient characteristics were recorded. Body mass index, disease activity scores, Mallampati classification, sternomental distance, thyromental distance, inter-incisor distance and atlanto-occipital joint extension were measured for each patient. Every patient was asked to complete the Stanford Health Assessment Questionnaire (HAQ score). Disease activity score (DAS 28 score) including 28 joints was used to assess the activity of the disease. Correlation between the predictors of difficult intubation and activity was assessed and was compared with the control group.
Results
Mallampati scores were higher (P = 0.000), sternomental distance (P = 0.005) and inter-incisor distance (P = 0.003) were shorter and also occlusal surface–upper teeth angle (P = 0.000) and mouth corner–tragus line angle were smaller in the rheumatoid arthritis group compared with controls (P = 0.000). We did not observe a correlation between the disease activity scores and the Mallampati score (P = 0.619), sternomental distance (P = 0.195), thyromental distance (P = 0.174), inter-incisor distance (P = 0.764), angle I (P = 0.372) and angle II (P = 0.609). There was no correlation between the HAQ score and the Mallampati score (P = 0.872), sternomental distance (P = 0.455), thyromental distance (P = 0.841), inter-incisor distance (P = 0.162), angle I (P = 0.768) and angle II (P = 0.287). There was no correlation between the duration of the disease and the Mallampati score (P = 0.619), sternomental distance (P = 0.505), thyromental distance (P = 0.426), inter-incisor distance (P = 0.813), angle I (P = 0.377) and angle II (P = 0.600).
Conclusion
Tests of disease activity and the duration of the disease were not found to be correlated with the predictors of difficult intubation in this study. Thus, performing the predictive tests for difficult intubation especially in patients with very low scores or short disease is recommended.
- Type
- Original Article
- Information
- Copyright
- Copyright © European Society of Anaesthesiology 2008
References
1.Mashio, H, Kojima, T, Goda, Y, Kawahigashi, H, Ito, Y, Kato, M. Intubation of a patient with rheumatoid arthritis with a 7.5-mm-ID armored endotracheal tube using a laryngeal mask airway. Masui 1997; 46 (12): 1639–1643.Google ScholarPubMed
2.Takakura, K, Hirakawa, S, Kudo, K, Mori, M, Kitano, T, Noguchi, T. Cricoarytenoid arthritis diagnosed after tracheostomy in a rheumatoid arthritis patient. Masui 2005; 54 (6): 690–693.Google Scholar
3.Yonemoto, N, Nagahata, T, Nishimura, T, Kato, H, Kitaguchi, K, Furuya, H. Difficult airway management during emergency tracheostomy in a patient with severe rheumatoid arthritis. Masui 2005; 54 (1): 39–41.Google Scholar
4.Celiker, R, Gökçe-Kutsal, Y, Eryilmaz, M. Temporomandibular joint involvement in rheumatoid arthritis. Relationship with disease activity. Scand J Rheumatol 1995; 24 (1): 22–25.CrossRefGoogle ScholarPubMed
5. Harris ED Jr, Budd RC, Firestein GS. Kelley’s Textbook of Rheumatology, 7th edn. Philadelphia, USA: Elsevier Saunders, 2005.Google Scholar
6.Bruce, B, Fries, JF. The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol 2003; 30 (1): 167–178.Google ScholarPubMed
7.Dougados, M, Aletaha, D, van Riel, P. Disease activity measures for rheumatoid arthritis. Clin Exp Rheumatol 2007; 25 (5 Suppl 46): S22–S29.Google ScholarPubMed
8.Vaughan, JH. Pathogenetic concept and origins of rheumatoid factors in rheumatoid arthritis. Arthritis Rheum 1993; 36: 1–5.CrossRefGoogle ScholarPubMed
9.Samsoon, GL, Young, JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487–490.CrossRefGoogle ScholarPubMed
10.Savva, D. Prediction of difficult tracheal intubation. Br J Anaesth 1994; 73: 149–153.CrossRefGoogle ScholarPubMed
11.Gillespie, NA. Endotracheal Anaesthesia, 2nd edn.Madison, USA: Universityof Wisconsin Press, 1950.Google Scholar
12.Gupta, S, Sharma, R, Jain, J. Airway assessment: predictors of difficult airway. Indian J Anaesth 2005; 49: 257–262.Google Scholar
13.Emery, P, Breedveld, FC, Lemmel, EM et al. A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology (Oxford) 2000; 39: 655–665.CrossRefGoogle ScholarPubMed
14.Smolen, JS, Kalden, JR, Scott, DL et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet 1999; 353: 259–266.CrossRefGoogle ScholarPubMed
15.Langeron, O, Amour, J, Vivien, B, Aubrun, F. Clinical review: management of difficult airways. Crit Care 2006; 10 (6): 243.CrossRefGoogle ScholarPubMed
16. Koopman WJ, Moreland LW. Arthritis and Allied Conditions, 15th edn. Philadelphia, USA: Lippincott Williams & Wilkins, 2005.Google Scholar
17.Yoshida, A, Higuchi, Y, Kondo, M, Tabata, O, Ohishi, M. Range of motion of the temporomandibular joint in rheumatoid arthritis: relationship to the severity of disease. J Dent 1993; 21 (3): 141–146.Google Scholar
18.Komusi, T, Munro, T, Harth, M. Radiologic review: the rheumatoid cervical spine. Semin Arthritis Rheum 1985; 14: 187–195.CrossRefGoogle ScholarPubMed
19.Ezri, T, Szmuk, P. Recent trends in tracheal intubation: emphasis on the difficult airway. Curr Opin Anaesthesiol 2004; 17 (6): 487–490.CrossRefGoogle ScholarPubMed
20.Quoss, A, Buurman, C. Anesthesiological considerations in rheumatic diseases. Anaesthesiol Reanim 2000; 26 (5): 116–121.Google ScholarPubMed
21.Merah, NA, Wong, DT, Ffoulkes-Crabbe, DJ, Kushimo, OT, Bode, CO. Modified Mallampati test, thyromental distance and inter-incisor gap are the best predictors of difficult laryngoscopy in West Africans. Can J Anaesth 2005; 52 (3): 231–235.CrossRefGoogle ScholarPubMed
22.Pottecher, Th, Velten, M, Galani, M, Forrler, M. Comparative value of clinical signs of difficult tracheal intubation in women [in French]. Ann Fr Anesth Reanim 1991; 10: 430–435.CrossRefGoogle ScholarPubMed
23.Wilson, ME, Spiegelhalter, D, Robertson, JA, Lesser, P. Predicting difficult intubation. Br J Anaesth 1988; 61 (2): 211–216.CrossRefGoogle ScholarPubMed
24.el-Ganzouri, AR, McCarthy, RJ, Tuman, KJ, Tanck, EN, Ivankovich, AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82 (6): 1197–1204.Google ScholarPubMed