From the Guidelines
For managing oral ulcers in lupus patients, I recommend starting with topical treatments such as triamcinolone acetonide 0.1% dental paste applied directly to ulcers 2-3 times daily after meals, or dexamethasone 0.5 mg/5mL elixir as a mouth rinse for 2 minutes then spit, 4 times daily, as these treatments have been shown to be effective in reducing inflammation and promoting healing 1. The management of oral ulcers in lupus patients requires a comprehensive approach that takes into account the underlying disease activity and the patient's quality of life.
- Topical treatments are the first line of treatment for oral ulcers, and they can provide significant relief from symptoms.
- For painful ulcers, lidocaine 2% viscous solution can provide temporary relief, and maintaining good oral hygiene is essential to prevent further irritation and promote healing.
- If topical treatments are ineffective, systemic medications that help control lupus activity may be necessary, including hydroxychloroquine (200-400 mg daily), which often improves mucocutaneous manifestations within 2-3 months, as recommended by the EULAR guidelines for the management of systemic lupus erythematosus 1.
- For severe or resistant cases, short courses of systemic corticosteroids (prednisone 20-40 mg daily for 5-7 days) or immunosuppressants like azathioprine or mycophenolate mofetil may be required, as they can help reduce inflammation and modulate the immune response that triggers ulcer formation in lupus.
- Avoiding spicy, acidic, or rough-textured foods during flares can prevent further irritation and promote healing, and patients should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile, and preventative strategies should be tailored accordingly 1. The diagnosis and treatment of oral ulcers in lupus patients can be challenging, and a comprehensive approach that takes into account the underlying disease activity and the patient's quality of life is essential to improve outcomes and survival, as highlighted by the expert consensus guideline for diagnosis of difficult and complicated oral ulceration 1.
From the Research
Oral Ulcer with Lupus
- Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a relapsing-remitting course, and oral ulcers are one of the common manifestations of SLE 2.
- The most frequently associated oral manifestations with SLE are oral ulcers, hyposalivation, pigmentations, glossodynia, cleft tongue, cheilitis, arthritis, and secondary Sjögren's syndrome 2.
- Intralesional steroid therapy (IST) may be an effective treatment for inflammatory and immune-mediated oral ulcers, with complete resolution achieved in 81.7% of patients in a median of 96 days 3.
Treatment of Oral Ulcers in Lupus
- Triamcinolone may lead to a more rapid response than oral methylprednisolone in treating mild/moderate flare in patients with lupus, with 69.5% of patients showing some improvement at day one compared to 41.6% in the oral methylprednisolone group 4.
- Intralesional triamcinolone acetonide therapy has been used to treat inflammatory oral ulcers, with a median dose of 12 mg per injection and a median of 2 injections required for complete resolution 3.
- A multidisciplinary approach is needed for dental and medical management of SLE patients, with early oral management necessary to improve oral health-related quality of life and prevent the need for more invasive therapeutics 5.
Oral Health in Lupus Patients
- SLE patients are more at risk of compromised oral and dental health, exhibiting increased risk of periodontal diseases and temporomandibular joint disorders 5.
- The use of systemic drugs, especially immunosuppressive and anticoagulants, in SLE patients may also influence their oral management 5.
- Regular oral health check-ups and a comprehensive treatment plan are essential for SLE patients to prevent oral complications and improve their overall quality of life 5, 2.