Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study

International Journal of Rheumatology, Apr 2018

Objective. The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods. Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results. Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion. This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways.

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Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study

Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study Mohammed Hammoudeh,1 Ahmed Al-Momani,2 Husam Sarakbi,1 Prem Chandra,3 and Samer Hammoudeh4 1Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar 2Department of Dentistry, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar 3Medical Research Center, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar 4Research Department, Weill Cornell Medicine-Qatar, P.O. Box 24144, Doha, Qatar Correspondence should be addressed to Mohammed Hammoudeh; aq.damah@heduomahm Received 7 December 2017; Revised 11 February 2018; Accepted 11 March 2018; Published 10 April 2018 Academic Editor: Charles J. Malemud Copyright © 2018 Mohammed Hammoudeh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objective. The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods. Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results. Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion. This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways. 1. Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which involves the connective tissue [1–3]. Several organs are also involved such as the brain, lungs, kidneys, heart, blood vessels, muscles, and skin [4]. SLE is more common among women [5–7], with a common onset between 15 and 40 years of age [4]. Researchers reported a prevalence rate of 30–50 cases per every 100,000, while incidence rates ranged from 0.9 to 3.1% among every 100,000 per year, among Asian populations [8]. In Saudi Arabia, a prevalence rate of 19.28 per 100,000 has been reported [9]. Globally, a prevalence rate of 12–50 cases per every 100,000 has been reported [10], while an incidence rate ranging from 0.3 in Ukraine to 11 in Australia cases per every 100,000 has been reported [11]. Common symptoms of SLE include fever, weight loss, glomerulonephritis, alopecia, rash, and vesiculobullous lesions [12]. Other manifestations such as arthralgia and arthritis are frequently seen, with migratory arthritis affecting about 75% of patients [4]. Oral manifestations of SLE are frequently encountered [13] and may include oral ulceration, honeycomb plaque, raised keratotic plaque, nonspecific erythema, purpura, petechiae, and cheilitis [14]. Research shows that 25% of SLE patients have oral mucous membrane and lip involvement with possible petechiae. Both xerostomia and hyposalivation predispose patients with SLE to dental caries and recurrent noninfectious pharyngitis and oral ulcerations. Oral candidiasis and infections are also common due to the usage of corticosteroid which is used in the treatment of SLE [4]. The most common oral manifestation reported to be present among SLE patients is oral ulcerations [3], with a prevalence rate ranging between 7 and 41%, which is observed to be more severe as the disease [15]. Others reported a prevalence rate of 8–45% for oral lesions among SLE [16]. A study conducted in Venezuela on 90 systemic and cutaneous lupus erythematosus patients reported that 11% had oral lesions including oral ulcerations, erythema, and white plaque [17]. A study conducted in Saudi Arabia on 46 SLE patients reported mucocutaneous involvement including oral ulcers in 72% and discoid lupus in 13% of the sample [18]. Among the oral manifestatio (...truncated)


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Mohammed Hammoudeh, Ahmed Al-Momani, Husam Sarakbi, Prem Chandra, Samer Hammoudeh. Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study, International Journal of Rheumatology, 2018, 2018, DOI: 10.1155/2018/6052326