Abstract
The citrullination process is exaggerated in rheumatoid arthritis, leading to abnormal accumulation of citrulline. Antibodies are released, triggering an autoimmune inflammatory process. Methotrexate, an antimetabolite and antifolate drug, used in arthritis, leads to myelosuppression favoring the appearance of opportunistic infections. Methotrexate therapy has side effects, which include oral manifestations. This report aimed to describe a case of periodontal disease with osteolysis of the mandible associated with rheumatoid arthritis and methotrexate therapy. A 38-year-old female presented a history of tooth mobility. Radiographic examination showed horizontal bone loss exceeding the middle third of the roots, in addition to bone rarefaction throughout the body of the mandible. Fine needle aspiration and an excisional biopsy with curettage of one of the lesions were performed, which yielded an inconclusive report. In the imaging follow-up, bone neoformation was observed in the biopsy region. The citrullination process is exaggerated in rheumatoid arthritis, leading to abnormal accumulation of citrulline. Antibodies are released, triggering an autoimmune inflammatory process. Methotrexate, an antimetabolite and antifolate drug, used in arthritis, leads to myelosuppression favoring the appearance of opportunistic infections. Methotrexate therapy has side effects, which include oral manifestations. This report aimed to describe a case of periodontal disease with osteolysis of the mandible associated with rheumatoid arthritis and methotrexate therapy. A 38-year-old female presented a history of tooth mobility. Radiographic examination showed horizontal bone loss exceeding the middle third of the roots, in addition to bone rarefaction throughout the body of the mandible. Fine needle aspiration and an excisional biopsy with curettage of one of the lesions were performed, which yielded an inconclusive report. In the imaging follow-up, bone neoformation was observed in the biopsy region.
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