Laryngeal arthritis is a rare manifestation of JRA. The difficulty of indirect laryngoscopy in small children has precluded the type of study which has demonstrated this manifestation in up to one quarter of arthritic adults. Recognition of cricoarytenoid arthritis in the patient reported might have prevented the need for tracheostomy, and eventually led to satisfactory reduction of corticosteroid medication and healing of the tracheostomy stoma.