Association between oral lesions and disease activity in lupus erythematosus

Abstract

Background Mucosal involvement is frequently seen in cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). There is no consensus regarding the prevalence, and a wide range of lesions has been reported. Its prognostic significance is currently unknown and a matter of controversy. Objective To classify oral lesions in lupus, evaluate their prevalence and assess their possible association with disease activity. Methods We conducted a descriptive study between 2016 and 2017. A total of 150 lupus patients were matched by sex, age and smoking status with 151 healthy individuals. All subjects underwent a careful evaluation of oral mucosa. On the same day of the clinical assessment, each patient underwent a peripheral venous blood and urine analysis. All patients underwent a full medical history, physical examination and a careful examination of the oral cavity. For each one, we obtained photographs of ten areas of the oral cavity. Two dermatologists of our group blindly recorded the presence and morphology of oral lesions. The disease activity of CLE patients was scored using the Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index, and in SLE patients, activity was measured using the Systemic Lupus Erythematosus Disease Activity Index. Results In CLE patients, there was a statistically significant correlation between higher cutaneous disease activity and the following oral findings: discoid plaques, cobblestone and red/brown‐pigmented macules. In patients with CLE, red macules on jugal mucosa were statistically associated with anaemia and positive antinuclear antibodies titres; additionally, the presence of gingivitis was related to systemic inflammation. In SLE patients, gingival telangiectases were statistically significantly associated with leucopenia, hypocomplementemia and systemic inflammation. Limitations Biopsies on mucosal lesions were not performed. Conclusion Some specific oral lesions correlate with disease activity in CLE and SLE.

Clinical characteristics of oral mucosal lesions in patients with systemic lupus erythematosus and their association with clinical and laboratory parameters

“…Noteworthy, the group of patients with LEOL showed a higher correlation with serological markers in comparison to patients with cutaneous or systemic activity, with the exception of articular disease. In a recent study including cutaneous and systemic LE-patients [26], erosions, white reticular plaques and telangiectasias displayed associations with anti-dsDNA antibodies but no strong relationship was observed with the presence of LE-ulcers, similar to our findings [26,35]. Further research focused on LEOL is required to allow the characterization of LEOL as a potentially useful clinical parameter in the prediction and evaluation of serologic and clinical activity in LE disease, as our results suggest.…”

“…Concerning to mouth diseases, the clinical descriptions of LEOL represent a singular problem [4,6,9,14,26]. Details of the characteristics in LEOL are scarcely documented [4,14,16] and there is a lack of clinical and histopathological consensus to define them [4,27,28].…”

“…Among Venezuelan LE patients, who are ethnically similar to the Mexican population, these lesions have been attributed to the use of antimalarials [24]. Other authors found a relationship with LE activity and pigmented macules [26], but such lesions could also be explained as a consequence of postinflammatory damage on oral mucosa. In our analysis, after adjusting for multiple variables, we did not find an association between oral melanosis and antimalarials, LE activity or smoking (data not shown).…”

Oral Ulceration in Systemic Lupus Erythematosus in Iraqi Patients and the Levels of Serum Vascular Endothelial Growth Factor-A

“…Oral ulcer (OU) may be one of the important symptoms in SLE that changes with disease activity [6] mentioned that ulcerations of the oral cavity in the long setting of SLE have been considered as predictors of systemic vasculitis and worse prognosis, while [19,20] stated that oral features of SLE are frequently encountered and may include oral ulceration, raised keratotic plaque, honeycomb plaque, and nonspecific erythema, finally the involvement of oral mucosa is frequently seen in (CLE) and (SLE) regarding the prevalence, a wide range of lesions has been reported [21] .…”

Cutaneous Manifestations of “Lupus”: Systemic Lupus Erythematosus and Beyond

“…The characteristic histopathology seen in mucosal lupus lesions include interface mucositis with lymphocytic infiltrate, necrotic keratinocytes, and hydropic degeneration of the basal layer. DIF is frequently positive, often demonstrating linear deposition of IgM, IgG, and C3 in the basement membrane zone [ 62 ].…”