Oral mucosa involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

Objectives: To estimate the frequency and character of oral mucosal lesions in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Furthermore, the relation between oral mucosal involvement and hyposalivation was investigated. Design: Case-control study. Setting: Rheumatology Clinic, University Hospital "Mother Theresa" in Tirana, Albania. Participants: 124 consecutive hospitalised patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender- matched healthy controls. Methods: Oral lesions were clinically examined and classified according to their morphologic aspects and localisation. Examination included also measurement of unstimulated whole salivary flow. Main outcome measures: Frequency of oral mucosal lesions and hyposalivation. Results: Oral mucosal lesions were observed in 58.9% of patients, but in only 33.1% of control subjects. Clinical aspects of lesions varied, and palate, buccal and labial mucosa, and tongue were the most affected sites. No significant associations were found between presence of oral lesions and hyposalivation, except oral candidosis which was associated with hyposalivation in controls. Conclusions: Patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis have a higher burden of oral mucosa disease than a healthy population. Collaboration of rheumatology and oral medicine units should allow appropriate management of these patients.