Stratification of methotrexate‐induced oral ulcers in rheumatoid arthritis patients

Abstract

Aim: There is a deficiency in the data concerning the clinical forms of methotrexate-induced oral ulcers. This study was conducted to stratify clinical forms of methotrexate-induced oral ulcers in rheumatoid arthritis patients. Methods: This study included rheumatoid arthritis patients receiving methotrexate as monotherapy. All eligible patients were subjected to thorough clinical examination and full history to identify oral events. Drug history, dose, and duration of MTX were recorded.Results: Among 794 rheumatoid arthritis patients, mean methotrexate dose and duration were 14.3 mg/week and 5.2 years, respectively. Oral ulcers were detected in 6.2% of the patients and 30% of the patients reported previous oral ulcers. Among the detected oral ulcers, 44.9% manifested as deep irregular ulcers, 30.6% presented as aphthous-like ulcers, 14.3% were diffuse mucositis, and 10.2% appeared as lichenoid reaction. Conclusion: Methotrexate-induced oral ulceration could be localized or generalized. Localized forms were more noticed than generalized forms. Higher doses and longer durations of methotrexate were detected among patients with generalized oral ulcers.

Oral Manifestations of Erythema Multiforme due to Methotrexate Intoxication

“…The oral ulcers as manifestations of EM related to MTX are rare and there is not one case reported in the literature. Despite this condition, a study showed 6.2 % of oral ulcers in patients receiving MTX (Magdy & Ali, 2021), but there is no information as to this resulting in EM. These considerations made this case report relevant to physicians, nurses and dentists to diagnose and treat patients with oral ulcers and EM.…”

“…Studies have shown a higher prevalence of EM in young adult men (20 to 40 years) (Hani et al, 2000;Blanes et al, 2005;Sanchis et al, 2010;Celenano et al, 2015;Kechichian et al, 2018;Magdy & Ali, 2021), however, in the current clinical case and most cases of EM associated with the use of MTX used in Table I (9/11), were women over the age of 50 (Omoregie et al, 2011;Troeltzsch et al, 2013;Jimbu & Demitsu, 2014;Lee et al, 2015;Katsoulas et al, 2016;Nam, 2018). Certainly, cases of EM associated with the use of MTX in women and older age groups may be related to a higher incidence of arthritis and psoriasis in adult women, in addition to the fact that the elderly population has more comorbidities and uses a greater amount of medication.…”