RESUMO
BACKGROUND AND AIMS: Spondyloarthritis (SpA) is a group of autoinflammatory disorders, of which the primary extra-articular manifestation is inflammatory bowel disease (IBD). The oral cavity being a part of gastrointestinal tract, is significantly compromised in IBD, and in many cases, it is the first site of clinical manifestations of IBD. This study aimed to identify changes in the oral mucosa associated with the onset of IBD and their association with endoscopic/histological findings. MATERIALS AND METHODS: The study assessed 80 patients with SpA and 52 healthy controls. Oral, rheumatological, and gastroenterological assessments were performed. The ileocolonoscopy was performed via digital magnification chromoendoscopy. The statistical analysis consisted of Chi-square, Fisher's exact, and multiple correspondence discriminant analysis tests. RESULTS: From the disease cohort, 63.0% patients showed oral lesions (p = 0.050). These manifestations ranged from gingivitis (55.0%, p = 0.001), aphthous stomatitis (3.8%, p = 0.091), angular cheilitis (2.6%, p = 0.200), and perioral erythema with scaling (1.3%, p = 0.300). All patients who presented with alterations in colonic mucosa also had oral lesions associated with IBD (p = 0.039), specifically gingivitis/aphthous stomatitis (p = 0.029). CONCLUSION: The patients with SpA without IBD present significant oral signs and symptoms. Gingivitis seems to be the most relevant because of its associations with early endoscopic and histological findings. CLINICAL RELEVANCE: An integral approach to the diagnostic tests that includes evaluations of oral, rheumatological and gastroenterological tissues may favor timely attention and improve patients' quality of life.
Assuntos
Gengivite , Doenças Inflamatórias Intestinais , Úlceras Orais , Doenças Reumáticas , Espondilartrite , Estomatite Aftosa , Humanos , Estomatite Aftosa/complicações , Qualidade de Vida , Espondilartrite/complicações , Doenças Inflamatórias Intestinais/complicações , Doença Crônica , Doenças Reumáticas/complicaçõesRESUMO
OBJECTIVE: To describe clinical, diagnostic and therapeutic characteristics of the periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. DATA SOURCE: Literature review in the PubMed database by using specific descriptors to identify all articles published in the English language in the last three years; 38 articles were found. After performing selection of titles and abstract analysis, 13 out of the 38 articles were fully read. Relevant studies found in the references of the reviewed articles were also included. DATA SYNTHESIS: The PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis and cervical Adenitis) is a medical condition grouped among the periodic fever syndromes. The etiology is uncertain, but possibly multifactorial, and its symptoms are accompanied by recurrent febrile episodes although weight and height development are preserved. It is a self-limiting disease of benign course with remission of two to three years without significant interference in the patient's overall development. Treatment consists of three pillars: interruption of febrile episodes, increase in the interval between episodes, and remission. CONCLUSIONS: Despite several attempts to establish more sensitive and specific criteria, the diagnosis of PFAPA syndrome is still clinical and reached by exclusion, based on the modified Marshall's criteria. The most common pharmacological options for treatment include prednisolone and betamethasone; colchicine may be used as prophylaxis, and surgical treatment with tonsillectomy can be considered in selected cases.
Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Criança , Febre/diagnóstico , Febre/etiologia , Humanos , Linfadenite/complicações , Linfadenite/diagnóstico , Linfadenite/terapia , Faringite/complicações , Faringite/diagnóstico , Faringite/terapia , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/terapia , SíndromeRESUMO
OBJECTIVES: To evaluate the role of Helicobacter pylori and other risk factors in recurrent aphthous stomatitis (RAS). METHODS: Patients with functional dyspepsia responded to questionnaires regarding demographic and clinical data, anxiety and depression, and a specific RAS questionnaire. They underwent upper digestive endoscopy and H. pylori evaluation. RESULTS: 476 patients were included and of the 372 evaluated for H. pylori, 65.6% were H. pylori-positive. RAS was reported by 32.6% (155/476). In the bivariate analysis of the 372 patients evaluated for gastric H. pylori status, positive subjects had a lower RAS prevalence (29.9%; 73/244) than H. pylori-negative (41.4%; 53/128) (p = .026). Smoking (p = .005) and older age (p = .034) were also associated with a lower prevalence, while female gender (p = .032) and lower income (p = .046) presented higher RAS prevalence. In the multivariate analysis, H. pylori infection (p = .017), smoking (p = .001), and older age (p = .013) were protective factors, while lower income (p = .030) and anxiety (p = .042) were risk factors. In the multivariate analysis of all patients, female gender, lower income, and more schooling years were risk factors. CONCLUSIONS: An unexpected lower prevalence of RAS was found in H. pylori-positive patients. Smoking, sex, age, income, education, and anxiety were associated with RAS.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Estomatite Aftosa , Idoso , Estudos Transversais , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Prevalência , Fatores de Risco , Estomatite Aftosa/complicações , Estomatite Aftosa/epidemiologiaRESUMO
The coronavirus disease 2019 (Covid-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin-converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid-19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid-19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid-19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid-19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS-CoV-2 exhibits tropism for endothelial cells and Covid-19-mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid-19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune-mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid-19 subjects, indicating SARS-CoV-2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS-CoV-2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.
Assuntos
COVID-19/complicações , Gengivite Ulcerativa Necrosante/complicações , Infecções por Herpesviridae/complicações , Úlceras Orais/complicações , Doenças Periodontais/complicações , Sialadenite/complicações , Estomatite Aftosa/complicações , Xerostomia/complicações , Enzima de Conversão de Angiotensina 2/genética , Enzima de Conversão de Angiotensina 2/imunologia , Anosmia/complicações , Anosmia/imunologia , Anosmia/patologia , Anosmia/virologia , COVID-19/imunologia , COVID-19/patologia , COVID-19/virologia , Disgeusia/complicações , Disgeusia/imunologia , Disgeusia/patologia , Disgeusia/virologia , Expressão Gênica , Gengivite Ulcerativa Necrosante/imunologia , Gengivite Ulcerativa Necrosante/patologia , Gengivite Ulcerativa Necrosante/virologia , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/patologia , Infecções por Herpesviridae/virologia , Humanos , Boca/imunologia , Boca/patologia , Boca/virologia , Úlceras Orais/imunologia , Úlceras Orais/patologia , Úlceras Orais/virologia , Doenças Periodontais/imunologia , Doenças Periodontais/patologia , Doenças Periodontais/virologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , Serina Endopeptidases/genética , Serina Endopeptidases/imunologia , Sialadenite/imunologia , Sialadenite/patologia , Sialadenite/virologia , Estomatite Aftosa/imunologia , Estomatite Aftosa/patologia , Estomatite Aftosa/virologia , Xerostomia/imunologia , Xerostomia/patologia , Xerostomia/virologiaRESUMO
RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.
ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Estomatite Aftosa/complicações , Deficiência de Vitamina B 12/tratamento farmacológico , /tratamento farmacológico , Deficiências Nutricionais , Deficiência de Ácido Fólico/tratamento farmacológicoRESUMO
We reviewed the medical records of patients with periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) to investigate the clinical course, treatment response, and association with MEFV gene mutation. Familial Mediterranean fever should be considered in patients with PFAPA who do not respond to adenotonsillectomy.
Assuntos
Adenoidectomia , Febre Familiar do Mediterrâneo/diagnóstico , Linfadenite/diagnóstico , Faringite/diagnóstico , Pirina/genética , Estomatite Aftosa/diagnóstico , Tonsilectomia , Criança , Pré-Escolar , Diagnóstico Diferencial , Doenças Endêmicas , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/epidemiologia , Febre Familiar do Mediterrâneo/genética , Feminino , Marcadores Genéticos , Heterozigoto , Humanos , Lactente , Linfadenite/complicações , Linfadenite/epidemiologia , Linfadenite/cirurgia , Masculino , Mutação , Faringite/complicações , Faringite/epidemiologia , Faringite/cirurgia , Estudos Retrospectivos , Estomatite Aftosa/complicações , Estomatite Aftosa/epidemiologia , Estomatite Aftosa/cirurgia , Síndrome , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
Inflammatory bowel diseases (IBD) are known as chronic inflammatory disorders of the digestive tract, represented mainly by Crohn's disease (CD) and ulcerative colitis (UC). Among the main oral manifestations of IBD are cobblestoning of the oral mucosa, labial swellings with vertical fissures, pyostomatitis vegetans, angular cheilitis, perioral erythema, and glossitis. In this sense, understanding these nosological entities by dentists would help reach early and differential diagnosis. Thus, two case reports are presented and discussed based on theoretical references obtained by a literature review. The first case report refers to an adult patient whose IBD diagnosis was established after stomatological assessment. The second case was a patient with CD diagnosed in childhood with characteristic oral lesions.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Doenças da Boca/complicações , Adolescente , Adulto , Deficiência de Vitaminas/fisiopatologia , Colite Ulcerativa/complicações , Comorbidade , Doença de Crohn/complicações , Odontologia/métodos , Diagnóstico Diferencial , Humanos , Inflamação , Masculino , Mucosa Bucal/patologia , Prevalência , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnósticoRESUMO
A ulceração aftosa recorrente (UAR) é considerada a doença ulcerativa mais frequente da cavidade bucal. Sua etiopatogenia ainda não está plenamente esclarecida, embora inúmeros fatores locais e sistêmicos já tenham sido a ela associados. Recentemente, a resposta imune anormal do tipo celular tem sido considerada a responsável pela lesão bucal na UAR, favorecendo uma resposta imunológica pró-inflamatória do tipo Th1, em conjunto com alterações em linfócitos T regulatórios. Sendo assim, o objetivo do presente estudo foi realizar análise da expressão gênica da FOXP3, MIP-3? e Interleucinas 2, 10 e 35 em pacientes com ulceração aftosa recorrente, por meio de estudo caso-controle. Os pacientes do grupo caso apresentavam quadros frequentes de UAR com pelo menos um ano de manifestação de surtos ulcerativos e história negativa de condições sistêmicas ou locais interferentes com a expressão das UAR. Estes foram submetidos a biópsia de lesão ulcerativa recente para a análise molecular. Os pacientes do grupo controle apresentavam história negativa de UAR, mucosa clinicamente saudável, e doaram voluntariamente fragmento de mucosa saudável para análise molecular, quando submetidos a procedimentos cirúrgicos como exodontia de terceiros molares ou biópsias ósseas. Todos os pacientes foram incluídos no grupo de pesquisa apenas após anuência
com termo de consentimento livre e esclarecido. Submeteram-se a exame clínico, realizaram exames complementares para controle da saúde geral e suporte diagnóstico. Onze pacientes UAR e três controles voluntários compuseram a casuística estudada, sendo submetidos a biópsia de lesões de UAR ou de mucosa de revestimento sadia. As amostras de tecido bucal foram submetidas aos procedimentos laboratoriais de extração do RNA e análise da expressão gênica da FOXP3, MIP-3? e Interleucinas 2, 10 e 35 por meio da técnica de RT-PCR em tempo real. Não houve diferença significativa na expressão dos genes estudados entre as amostras de portadores de UAR e controles sadios. Concluímos que os genes aqui avaliados não parecem desempenhar papel distintivo na fase ulcerativa inicial das UAR, entretanto estudos adicionais são recomendados a fim de se verificar a real participação desses agentes da inflamação na expressão da doença.
Recurrent aphthous ulcers (RAU) is the most common ulcerative disease of the oral cavity. Its pathogenesis is poorly understood yet, although numerous local and systemic factors have been associated with it. Recently, abnormal immune response of cellular type has been considered responsible for the RAU oral lesions, promoting a pro-inflammatory immune response Th1-type, in conjunction with changes in regulatory T cells. Thus, the aim of this study was to analyze the gene expression of FOXP3, MIP-3? and interleukins 2, 10 and 35 in patients with recurrent aphthous ulceration through a case-control study. The case group of patients presented frequent RAU bouts with at least one year of manifestation of ulcerative outbreaks and negative history of local or systemic conditions interfering with the RAU expression. These patients were submitted to a biopsy procedure of a recent ulcerative lesion for molecular analysis. Patients in the control group presented no history of RAU, and agreed with a donation of a healthy mucosa fragment for molecular analysis when undergoing surgical procedures such as extraction of third molars or bone biopsies.
All patients were included in the research group only after agreement with an informed consent. All subjects underwent clinical examination and were submitted to additional lab tests to check overall health and support diagnosis. Eleven RAU patients and three control volunteers composed the sample size and undergone biopsy of RAU lesions or healthy mucosal lining. The oral tissue samples were submitted to the laboratory procedures of RNA extraction and analysis of gene expression of FOXP3, MIP-3? and interleukins 2, 10, 35 by real time RT-PCR. There was no significant difference in gene expression between the studied samples of patients with RAU and healthy controls. It was concluded that the genes evaluated do not seem to play distinctive role in the initial ulcerative phase of RAU, however further studies are recommended in order to verify the actual participation of these inflammation agents in RAU expression.
Assuntos
Citocinas/uso terapêutico , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico , Interleucinas/administração & dosagem , Reação em Cadeia da Polimerase , Quimiocinas/uso terapêuticoRESUMO
Os aspectos moleculares envolvidos na expressão das estomatites aftosas recorrentes (EAR) vem, de forma crescente, auxiliando a compreensão e o desvendamento das bases etiopatogênicas da doença. Dessa forma, o objetivo deste trabalho foi o de traçar um perfil da expressão de quimiocinas e seus receptores em pacientes portadores de estomatite aftosa recorrente, desde que essas citocinas são responsáveis pelo tráfego de leucócitos e gerenciamento de várias vias de sinalização nas reações inflamatórias, visando contribuir com o entendimento das bases moleculares desta doença. Foram constituídos dois grupos de pacientes; um grupo caso composto por pacientes portadores de EAR, e um grupo controle composto por voluntários saudáveis sem história de EAR. Foram colhidas biópsias de lesões recentes de EAR no grupo caso e fragmentos de mucosa oral normal dos voluntários sadios. Extraiu-se o RNA dessas amostras, constituindo-se dois conjuntos (pools) de material genético: um do grupo caso e outro do grupo controle. Esse material foi utilizado em técnica de PCR-array, em placas contendo 84 genes codificadores de quimiocinas e seus receptores, além de outros genes relacionados. Os resultados mostraram superexpressão de 31 genes e hipoexpressão de outros sete, sendo que entre as quimiocinas avaliadas, 16 mostraram superexpressão e uma hipoexpressão. Entre os receptores, oito se superexpressaram e um mostrou-se hipoexpresso. Todas as quirniocinas superexpressas foram do tipo inflamatório, à exceção de duas (CCL 19, CXCL 13), sendo que as quimiocinas CXCL6, CXCL9, CXCL 10 e CXCL 11 mostraram expressão extremamente elevada. Concluímos que as quimiocinas desempenham papel importante na manifestação das EAR e que o perfil das quimiocinas superexpressas é do tipo inflamatório e associado à reação inflamatória do tipo Th1...
The molecular aspects associated to recurrent aphthous stomatitis (RAS) expression are increasingly aiding our understanding of the etiopathogenesis of this condition. Thus, the objective of this study was to draw a profile on the expression of chemokines and their receptors in patients with recurrent aphthous stomatitis, since these cytokines are responsible for the traffic of leukocytes and managing multiple signaling pathways in inflammatory reactions, aiming to contribute to the understanding of the molecular basis of this disease.Two groups of patients were constituted, a Case group consisting of patients with RAS, and a Control group composed of healthy volunteers with no history of RAS. Biopsies were taken from recent RAS lesions in the case group and fragments of normal oral mucosa of healthy volunteers. RNA was extracted from these samples constituting two sets (pools) of genetic material; one from case group and one from control group. This material was applied in PCR-array plates containing 84 genes encoding chemokines and their receptors, and other related genes. The results showed overexpression of 31 genes and hypoexpression of other seven. Among the chemokines genes evaluated, 16 showed overexpression and one hypoexpression. Among receptors eight were overexpressed and one showed hypoexpression .. Ali but two (CCL 19, CXCL 13) of the overexpressed chemokines were of inflammatory type. The inflammatory chemokines CXCL6, CXCL9, CXCL 10, and CXCL 11 showed extremely high expression .. It was concluded that chemokines play an important role in the manifestation of RAS and that the profile of verexpressed chemokines is of inflammatory type and associated to a Th1 inflammatory reaction...
Assuntos
Humanos , Citocinas/administração & dosagem , DNA , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico , Medicina Bucal , RNARESUMO
We report three familial cases of periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis syndrome, including a pair of monozygotic twins and their mother. It suggests that periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis syndrome may have a certain monogenetic background.