Iván Cusácovich

Oral Lesions in Rheumatology 1/8 The mouth can be the first clue to systemic rheumatic disease. An oral ulcer is not always “just an aphthous ulcer.” Here are 7 oral findings every rheumatologist should recognize. 2/8 | Behçet disease Recurrent oral ulcers? Think Behçet in the right clinical context. • Usually painful aphthae • Minor, major or herpetiform • Often an early manifestation • Ask about genital ulcers, eye & skin disease ⚠️ Oral ulcers alone ≠ Behçet disease. 3/8 | SLE Oral ulcers may involve the palate, buccal mucosa, lips or tongue and can be painless. Don't diagnose from the ulcer alone. Look for the bigger picture: Photosensitivity • alopecia • arthritis • cytopenias • renal involvement #Lupus 4/8 | Sjögren disease The oral clue isn't always an ulcer. Xerostomia leaves a mark. Think: • Dental caries • Oral candidiasis • Angular cheilitis • Atrophic/fissured tongue • Difficulty swallowing dry food The mouth can reveal salivary gland dysfunction. 5/8 | GPA One oral finding worth remembering: STRAWBERRY GINGIVITIS 🍓 Red, friable, granular gingival enlargement can be an important clue to granulomatosis with polyangiitis. Persistent unusual gingivitis + systemic features → think beyond periodontal disease. #Vasculitis 6/8 | Systemic sclerosis The oral clue isn't always inside the mouth. Look for: • Microstomia • Perioral tightening • Xerostomia • Dental/periodontal problems • Difficulty maintaining oral hygiene Examine how the patient opens the mouth—not just what's inside. 7/8 | RA: disease or drug? New oral ulcers in a patient with RA? Before attributing them to the disease, review the medications. With methotrexate, assess: dose/error • folate • renal function • interacting drugs • cytopenias Oral ulceration can be a toxicity signal. 8/8 | Oral lichen planus White lacy oral lesions → think lichenoid disease. • Reticular → Wickham striae • Erosive/atrophic → often painful Also consider: drug-induced lichenoid reaction • lupus • candidiasis • dysplasia Persistent/suspicious lesions → oral-medicine evaluation. The mouth is part of the rheumatological examination—not an afterthought. #Rheumatology #MedEd @IhabFathiSulima @docakx