Management of oral complications of disease-modifying drugs in rheumatoid arthritis.
Stomatitis is a troublesome adverse effect of disease-modifying anti-rheumatic drug (DMARD) therapy in rheumatoid arthritis (RA) patients.
This review presents data to examine the incidence, clinical features and consequences of DMARD-related stomatitis, and suggests an algorithm for its clinical management.
The specific objectives of the two studies presented here were to determine the incidence of DMARD-related stomatitis and its effect on DMARD continuation. and secondly to identify the clinical and laboratory risk factors.
We investigated two cohorts of patients :
(i) a retrospective survey of data collected from drug monitoring clinics run for patients on DMARDs from 1987 to 1994 involving 1539 patients and 2394 drug exposures ; (ii) a prospective study of 25 consecutive RA patients presenting with DMARD-related stomatitis compared to 29 RA controls with no history of DMARD stomatitis.
The retrospective survey showed that 2% of DMARD patients stopped therapy because of stomatitis, but 55% of these were able to resume the same therapy.
In the case-control study, 24% of patients discontinued temporarily and 8% permanently.
Cases of DMARD-related stomatitis differed from controls in that they had a higher incidence of previous mouth ulcers (40% vs 14%), they smoked less (8% vs 31%) and Schirmer's test was more often abnormal (44% vs 21%). There were no differences in RA severity, disease activity or oral hygiene. (...)
Mots-clés Pascal : Méthotrexate, Chimiothérapie, Immunodépresseur, Pénicillamine, Antirhumatismal, Toxicité, Stomatite, Infection, Herpès, Virose, Epidémiologie, Incidence, Symptomatologie, Traitement, Homme, Antifolate, Aminoacide soufré, Stomatologie, Cavité buccale pathologie
Mots-clés Pascal anglais : Methotrexate, Chemotherapy, Immunosuppressive agent, Penicillamine, Antirheumatic agent, Toxicity, Stomatitis, Infection, Herpes, Viral disease, Epidemiology, Incidence, Symptomatology, Treatment, Human, Antifolate, Sulfur containing aminoacid, Stomatology, Oral cavity disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0320092
Code Inist : 002B02U07. Création : 12/09/1997.