Abstract
Background. The frequency of recurrent aphthous ulcers (RAU) and their relationship with comorbidities has been scarcely described.Methods. We conducted a retrospective analytical study of patients with a presumptive diagnosis of RAU, in order to know the frequency of misdiagnosis of RAU, to delineate the clinical and biochemical characteristics of RAU, and to analyze their correlation with systemic diseases. Three groups of recurrent ulcers were analyzed: a) RAU, b) RAU associated to Behçet´s disease, and c) other recurrent ulcers misdiagnosed as RAU (OU). We recorded clinical and laboratory data. Statistics included Mantel-Haenszel chi square test, Kruskall-Wallis test, and Student´s t test.Results. A total of 141 patients (106 women) were referred with a presumptive diagnosis of RAU: 56 cases (39.7%) with RAU; 10 (7.1%) with RAU in Behçet´s disease, and 75 (53.2%) with OU. RAU subjects presented a lower frequency of rheumatologic diseases than patients with Behçet´s disease ulcers [30.4% vs 70.0%; (p=0.03)] and patients with OU [30.4% vs 54.7%; (p=0.007)]. Additionally, immunodeficiency was less common among patients with RAU in comparison to Behçet´s disease [3.6% vs 40.0%; (p=0.003)] and OU [3.6% vs 28.0%; (p‹0.001)].Higher levels of serum leukocytes were seen in Behçet´s disease [median=8.9 (range 5.3-9.7) x103 cells/mm3] when compared to RAU [median=6.0 (range 3.2-21.2) x103 cells/mm3] and OU [median=6.0 (range 2.3-14.8) x103 cells/mm3] (p<0.04).
 Conclusions. Misdiagnosis of RAU was frequent; an individual pattern of association to specific groups of systemic diseases was observed in each studied group of recurrent ulcers. RAU and Behçet´s disease ulcers showed clinical and laboratory differences.
Highlights
Oral aphthae are ulcerative, inflammatory lesions of the mucosa with specific clinical features and different etiologies
Oral aphthae may be isolated or present as part of systemic or specific diseases of the oral cavity [1,2]. They are painful, hindering food ingestion, which in turn may cause great morbidity [3,4]. They are known as recurrent aphthae, recurrent ulcers, canker sores, recurrent aphthous stomatitis, or recurrent aphthous ulcers (RAU) [5]
The prevalence of RAU may be highly variable, but at least 20% of the general population may be affected at some point of life [8]
Summary
Inflammatory lesions of the mucosa with specific clinical features and different etiologies. Oral aphthae may be isolated or present as part of systemic or specific diseases of the oral cavity [1,2]. They are painful, hindering food ingestion, which in turn may cause great morbidity [3,4]. Conclusions: Misdiagnosis of RAU was frequent; an individual pattern of association to specific groups of systemic diseases was observed in each studied group of recurrent ulcers. RAU and Behçets disease ulcers showed clinical and laboratory differences
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