Oral ulcers as early manifestation of systemic lupus erythematous

Abstract

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease which develops at the base of imperfect immunoregulatory processes, genetically determined and Associated with overproduction of autoantibodies. The symptoms are heterogeneous and each of those present has a major importance for the diagnosis and prognosis of disease. Oral ulcers were included in the criteria for classification of SLE, SLICC 2012, representing one of the most frequent mucocutaneous manifestation at the onset of the disease. According to the latest scientific evidence, skin involvement represented by oral ulcers, acute and chronic cutaneous lupus are present in the initial stages of SLE in 19-30% cases. Materials and methods: In performed cross sectional study were included patients that fulfilled SLICC classification criteria, 2012 and had a duration of the disease not more than 2 years. We were interested to find out the frequency of oral ulcers as initial sign of disease and its correlation with disease activity by SLEDAI. Patients were evaluated for the presence of oral ulcers as initial manifestation of the disease and correlated with disease activity at the moment of study entry. Discussion results: In our study were included 51 patients, mean age of patients at study entry was 37.2±13.2 (range 18-67) years, 83.2% were female and mean disease duration was 9.3±8.7 months. The frequency of the oral ulcers was 33.3%. The mean SLEDAI activity of a disease was 11.4±6.2 points (high), but it didn’t correlated with the duration of disease r=(-0.016), P=0.9. We also were interested to evaluate if disease activity can be a risk factor for oral ulcers in early lupus if we divide our patients in 4 groups – with oral ulcers and without/ low and high disease activity (<or> than 8 points). In the result,relative risk (RR) was 0.98 (low), with CI=0.4 to 2.25, P=0.9. When we appreciated the risk of ulcers in dependence of disease duration (<or> than 12 month) relative risk was 1.75 with CI=0.72 to 4.2, P=0.2. Conclusion: Oral ulcers are common manifestation in systemic lupus erythematosus and frequently can serve as one of the initial symptoms of the disease. This manifestation should be appreciated when other characteristic signs are present in diagnosis of LES and can be appreciated as criteria for disease activity and its presence in SLEDAI score as independent descriptor. When we analyze the effect of two factors - disease activity and duration on ulcer appearance we can conclude that 1: disease activity and oral ulcers are independent factors, 2: risk of oral ulcers appearance raises with disease progression, but not statistically semnificant.