Oral events related to low-dose methotrexate in rheumatoid arthritis patients

Carlos Henrique Silva Pedrazas,Sandra Regina Torres,Mario Newton Leitão De Azevedo

doi:10.1590/s1806-83242010000300018

Carlos Henrique Silva Pedrazas, Sandra Regina Torres + Show 1 more

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https://doi.org/10.1590/s1806-83242010000300018

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Abstract

Low-dose methotrexate (MTX) is frequently used for patients with rheumatoid arthritis (RA). High doses of MTX frequently produce side effects. The aim of this study was to explore oral complications of low-dose MTX therapy in a population of RA patients. This is a cross-sectional study in which oral examination was performed on a population of RA patients. Patients undergoing MTX therapy (5-20 mg weekly) for at least six months were included in the study group, and RA patients being treated under another regimen were used as controls. The frequency of oral lesions was compared between groups. The chi-square test was used to compare frequencies. Relative risk (RR) and its confidence interval (CI) were established. Significance level was set at 0.05. Twenty-eight RA patients on a low-dose MTX regimen and 21 controls were enrolled in the study. Oral lesions were found in 22 patients (78.6%) undergoing MTX therapy, and in 5 patients (23.8%) undergoing other therapies (p < 0.001). There were no significant differences regarding age, gender or dosage. The most common oral events observed in patients in the MTX group were ulcerative/erosive lesions (60.7%) and candidiasis (10.7%). Patients in the control group presented lower prevalence of the same lesions (p < 0.001). The RR for developing oral lesions was 11.73 (CI 2.57 - 58.98), with low-dose MTX therapy. In conclusion, the prevalence of oral mucosa lesions in RA patients receiving low doses of MTX therapy is higher than in RA patients not receiving the drug.

Highlights

Rheumatoid arthritis (RA) is the most common rheumatic disease, and low-dose methotrexate (MTX) is used extensively as a second line therapy in the treatment of RA
Sixteen patients were excluded for using MTX for less than six months, twenty-eight RA patients taking low doses of MTX (5-20 mg/week) were included in the study group, and twenty-one patients with RA being treated with drugs other than MTX were used as controls
Oral lesions were observed in 22 patients (78.6%) in the MTX group and in 5 patients (23.8%) undergoing regimens involving other therapies (p < 0.001) (Table 2)

Summary

Introduction

Rheumatoid arthritis (RA) is the most common rheumatic disease, and low-dose methotrexate (MTX) is used extensively as a second line therapy in the treatment of RA. Oral and intestinal epithelial cells are sensitive to the effects of MTX and may be frequently affected by mucositis.[1,10] Erythematous, erosive and ulcerative oral lesions may be a consequence of MTX therapy.[2,4,5,6,7,8] The aim of this cross-sectional study was to compare the findings regarding oral events of RA patients taking a low-dose MTX regimen with those of RA patients not taking MTX

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