From the Guidelines
Performing a rheumatic profile for a patient with repeated oral ulcers on the right side of the tongue with mild fever is not justified as a first-line investigation. The patient's symptoms, although painful and ulcerating, do not alone warrant rheumatologic testing, as recurrent oral ulcers are commonly caused by aphthous stomatitis, trauma, viral infections, or nutritional deficiencies 1. Initial evaluation should include a complete history, physical examination, and basic blood tests such as full blood count, coagulation, fasting blood glucose level, HIV antibody, and syphilis serology examination, as recommended by the expert consensus guideline for diagnosis of difficult and complicated oral ulceration 1.
Key considerations in the initial evaluation include:
- Collecting a thorough clinical medical history and performing an oral examination
- Considering a biopsy if the oral ulceration cannot be diagnosed after initial evaluation or if it does not respond to 1-2 weeks of treatment, with blood tests necessary before biopsy to exclude contraindications 1
- Ruling out infectious causes, given the presence of mild fever, which could suggest an invasive fungal infection, particularly in patients with high blood glucose 1
- Evaluating for serum specific antibodies if suspected bullous diseases are present 1
Symptomatic treatment with topical corticosteroids, antimicrobial mouthwashes, and pain management is more appropriate initially for isolated oral ulcers with mild fever. Rheumatologic testing might be considered if the ulcers persist beyond two weeks, are accompanied by other systemic symptoms, or if there's a family history of autoimmune disorders, as conditions like Behçet's disease, systemic lupus erythematosus, or inflammatory bowel disease can present with oral ulcers, but typically have additional manifestations 1.
From the Research
Repeated Oral Ulcer Diagnosis
The diagnosis of a repeated oral ulcer, painful and ulcerating on the right side of the tongue, with mild fever, involves considering various potential etiologies, including infections, autoimmune diseases, and other systemic diseases 2, 3.
Potential Causes
Some potential causes of repeated oral ulcers include:
- Traumatic ulceration
- Chemical ulceration
- Recurrent aphthous stomatitis
- Medication-related ulceration
- Infectious ulceration
- Mucocutaneous disease
- Autoimmune/systemic disease 2
- Autoimmune mechanism due to streptococcal antigens 4
Rheumatic Profile
Performing a Rheumatic (Rheumatoid) profile may be justified in cases where the oral ulcers are suspected to be associated with systemic diseases such as rheumatoid arthritis, lupus erythematosus, or other autoimmune disorders 4, 5.
Diagnostic Approach
A diagnostic algorithm for recurrent oral ulceration should be followed, which includes considering the patient's medical history, clinical presentation, and laboratory tests such as antistreptolysin O, rheumatoid factor, and C-reactive protein 4.
Clinical Evaluation
Any patient with recurring oral ulcers should be evaluated medically for the possible presence or future development of serious systemic diseases, including rheumatoid arthritis, Behçet's syndrome, and other autoimmune disorders 4, 6.