Autoimmune diseases and their various manifestations in the oral cavity – a systematic review

Authors

DOI:

https://doi.org/10.15584/ejcem.2023.3.16

Keywords:

autoimmune diseases, Behcet’s disease, lichen planus, lupus erythematous, rheumatoid arthritis, Sjögren’s syndrome

Abstract

Introduction and aim. Oral manifestation of the disorder is the leading cause of common initial features of most autoimmune diseases. Therefore, this study aimed to present different oral manifestations of selected autoimmune diseases.

Material and methods. We systematically reviewed the etiology, signs and symptoms, oral manifestations, epidemiology, diagnosis, treatment plan, and prognosis. We searched the articles on PubMed, Google Scholar and Web of Science for the following search term: Behcet’s disease, lichen planus, mucous membrane pemphigoid and bullous pemphigoid, pemphigus vulgarisms and paraneoplastic pemphigus, rheumatoid arthritis, Sjögren’s syndrome, IgG4-related disease, systemic lupus erythematous, and granulomatosis with polyangitis.

Analysis of the literature. We conducted that the disorder’s oral manifestation causes most autoimmune illnesses’ earliest symptoms.

Conclusion. Clinical-pathological is a piece of requisite knowledge for the dentist to recognize and diagnose in the early phase of the symptoms.

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References

Greco A, De Virgilio A, Ralli M, et al. Behçet’s disease: new insights into pathophysiology, clinical features and treatment options. Autoimmunity Reviews. 2018;17(6):567-575. doi: 10.1016/j.autrev.2017.12.006

Saccucci M, Di Carlo G, Bossù M, Giovarruscio F, Salucci A, Polimeni A. Autoimmune Diseases and Their Manifestations on Oral Cavity: Diagnosis and Clinical Management. J Immunol Res. 2018;2018:6061825. doi: 10.1155/2018/6061825

Mays JW, Sarmadi M, Moutsopoulos NM. Oral Manifestations of Systemic Autoimmune and Inflammatory Diseases: Diagnosis and Clinical Management. J Evid Based Dent Pract. 2012;12(3):265-282. doi: 10.1016/S1532-3382(12)70051-9

Chen J, Yao X. A Contemporary Review of Behcet’s Syndrome. Clin Rev Allergy Immunol. 2021;61(3):363-376. doi: 10.1007/s12016-021-08864-3

Özdede A, Hatemi G. An evaluation of apremilast for the treatment of adult patients with oral ulcers associated with Behçet’s syndrome. Expert Opin Pharmacother. 2021;22(12):1533-1537. doi: 10.1080/14656566.2021.1939307

Davatchi F, Chams-Davatchi Ch, Shams H, et al. Behcet’s Disease: Epidemiology, Clinical Manifestations, and Diagnosis. Expert Rev Clin Immunol. 2017;13(1):57-65. doi: 10.1080/1744666X.2016.1205486

Rios Scherrer MA, Barreto Rocha V, Campos Garcia L. Behçet´s disease: review with emphasis on dermatological aspects. An Bras Dermatol. 2017;92(4):452-464. doi: 10.1590/abd1806-4841.20177359

Rashid H, Lamberts A, Diercks GFH, et al. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol. 2019;20(6):847-861. doi: 10.1007/s40257-019-00461-7

Alibaz-Oner F, Direskeneli H. Advances in the Treatment of Behcet’s Disease. Curr Rheumatol Rep. 2021;23(6):47. doi: 10.1007/s11926-021-01011-z

Gualtierotti R, Marzano AV, Spadari F, Cugno M. Main Oral Manifestations in Immune-Mediated and Inflammatory Rheumatic Diseases. J Clin Med. 2018;8(1):21. doi: 10.3390/jcm8010021

Cheng YS, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(3):332-354. doi: 10.1016/j.oooo.2016.05.004

Schifter M, Yeoh SC, Coleman H, Georgiou A. Oral mucosal diseases: the inflammatory dermatoses. Aust Dent J. 2010;55(1):23-38. doi: 10.1111/j.1834-7819.2010.01196.x

Michael White C, Chamberlin K, Eisenberg E. Curcumin, a turmeric extract, for oral lichen planus: A systematic review. Oral Diseases. 2019;25:720-725. doi: 10.1111/odi.13034

Sankar V, Noujeim M. Oral Manifestations of Autoimmune and Connective Tissue Disorders. Atlas Oral Maxillofac Surg Clin North Am. 2017;25(2):113-126. doi: 10.1016/j.cxom.2017.04.004

Wei J, Ma D, Qiu M, et al. Medical treatments for pregnant patients with oral lichen planus. Acta Odontol Scand. 2017;75(1):67-72. doi: 10.1080/00016357.2016.1250944

Agha-Hosseini F, Barati H, Moosavi M-S. Aquaporin3 (AQP3) expression in oral epithelium in oral lichen planus. Exp Mol Pathol. 2020;115:104441. doi: 10.1016/j.yexmp.2020.104441

Mendes GG, Servato JP, Borges FC, et al. Differential metallothionein expression in oral lichen planus and amalgam-associated oral lichenoid lesions. Med Oral Patol Oral Cir Bucal. 2018;23 (3):e262-e268. doi: 10.4317/medoral.22144

Sen S, Sen S, Dutta A, Abhinandan, KV, Singh AK. Oral manifestation and its management in postmenopausal women: an integrated review. Menopause Rev. 2020;19(2):101-103. doi: 10.5114/pm.2020.97867

Chu S, Michelle L, Ekelem C, Sung CT, Rojek N, Mesinkovska NA. Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions. Arch Dermatol Res. 2021;313(6):391-430. doi: 10.1007/s00403-020-02152-4

Magliocca KR, Fitzpatrick SG. Autoimmune Disease Manifestations in the Oral Cavity. Surg Pathol Clin. 2017;10(1):57-88. doi: 10.1016/j.path.2016.11.001

Bagan J, Jiménez Y, Murillo J, Bagan L. Oral mucous membrane pemphigoid: A clinical study of 100 low-risk cases. Oral Dis. 2018;24(1-2):132-134. doi: 10.1111/odi.12744

Kuriachan D, Suresh R, Janardhanan M, Savithri V. Oral Lesions: The Clue to Diagnosis of Pemphigus Vulgaris. Case Rep Dent. 2015; 2015:593940. doi: 10.1155/2015/593940

Munhoz EA, Cardoso CL, Barreto JA, Soares CT, Damante JH. Severe manifestation of oral pemphigus. Am J Otolaryngol. 2011;32(4):338-342. doi: 10.1016/j.amjoto.2010.03.005

Paolino G, Didona D, Magliulo G, et al. Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy. Int J Mol Sci. 2017;18(12):2532. doi: 10.3390/ijms18122532

Sultan AS, Villa A, Saavedra AP, Treister NS, Woo SB. Oral mucous membrane pemphigoid and pemphigus vulgaris- a retrospective two-center cohort study. Oral Dis. 2017;23(4):498-504. doi: 10.1111/odi.12639

Said S, Golitz L. Vesiculobullous Eruptions of the Oral Cavity. Otolaryngol Clin N Am. 2011;44(1):133-160. doi: 10.1016/j.otc.2010.09.00544

McNamara KK, Kalmar JR. Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities. Head Neck Pathol. 2019;13(1):4-15. doi: 10.1007/s12105-019-01002-8

Mays JW, Carey BP, Posey R, et al. World Workshop of Oral Medicine VII: A systematic review of immunobiologic therapy for oral manifestations of pemphigoid and pemphigus. Oral Dis. 2019;25(1):111-121. doi: 10.1111/odi.13083

Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245-1252.

Cheng Z, Do T, Mankia K, et al. Dysbiosis in the oral microbiomes of anti-CCP positive individuals at risk of developing rheumatoid arthritis. Ann Rheum Dis. 2021;80(2):162-168. doi: 10.1136/annrheumdis-2020-216972

Manzano BR, da Silva Santos PS, Bariquelo MH, Merlini NRG, Honório HM, Rubira CMF. A case-control study of oral diseases and quality of life in individuals with rheumatoid arthritis and systemic lupus erythematosus. Clin Oral Investig. 2021;25(4):2081-2092. doi: 10.1007/s00784-020-03518-8

Radwan-Oczko M, Duś-Ilnicka I, Richards P, Thomsen AM, Rasmussen C. Rheumatoid arthritis patients’ oral health and disease activity. Int J Rheum Dis. 2019;22(8):1538-1543. doi: 10.1111/1756-185X.13590

Möller B, Kollert F, Sculean A, Villiger PM. Infectious Triggers in Periodontitis and the Gut in Rheumatoid Arthritis (RA): A Complex Story about Association and Causality. Front Immunol. 2020;11:1108. doi: 10.3389/fimmu.2020.01108

Rodrigues-Fernandes CI, Migliorati CA, Gueiros LAM, et al. Adalimumab-induced sarcoidosis-like reaction involving oral cavity in rheumatoid arthritis: a case-based review. Clin Rheumatol. 2021;40(9):3833-3839. doi: 10.1007/s10067-021-05654-2

Vivino FB, Carsons SE, Foulks G, et al. New Treatment Guidelines for Sjögren's Disease. Rheum Dis Clin North Am. 2016;42(3):531-551. doi: 10.1016/j.rdc.2016.03.010

Both T, Dalm VA, van HPM, van DPL. Reviewing primary Sjögren’s syndrome: beyond the dryness - From pathophysiology to Diagnosis and treatment. Int J Med Sci. 2017;14(3):191-200. doi: 10.7150/ijms.17718

Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska-Siudek K. Sjögren’s syndrome: still not fully understood disease Rheumatol Int. 2015; 35:233-241.

Shiboski CH, Shiboski SC, le Seror, et al. American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome. A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts Ann Rheum Dis. 2017;76:9-16.

Shiboski CH, Shiboski SC, Seror R. 2016 America College of Rheumatology/European League Against Rheumatism Classification Criteria for primary Sjögren’s syndrome. Arthritis Rheumatol. 2017;69:35-45.

Maślińska M. The role of Epstein-Barr virus infection in primary Sjögren's syndrome. Curr Opin Rheumatol. 2019; 31(5):475-483. doi: 10.1097/BOR.0000000000000622

Schmalz G, Patschan S, Patschan D, Ziebolz D. Oral-Health-Related Quality of Life in Adult Patients with Rheumatic Diseases—A Systematic Review. J Clin Med. 2020;9(4):1172. doi: 10.3390/jcm9041172

Błochowiak KJ, Olewicz-Gawlik A, Trzybulska D, et al. Serum ICAM-1, VCAM-1 and E-selectin levels in patients with primary and secondary Sjögren's syndrome. Adv Clin Exp Med. 2017 ;26(5):835-842. doi: 10.17219/acem/61434

Błochowiak K, Olewicz-Gawlik A, Polańska A, Nowak-Gabryel M, Kocięcki J. Oral mucosal manifestations in primary and secondary Sjögren’s syndrome and dry mouth syndrome. Post Derm Alerg, 2016;33(1):23-27.

Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The Diagnosis and Treatment of Sjögren’s Syndrome. Dtsch Arztebl Int. 2017;114(20):354-361. doi: 10.3238/arztebl.2017.0354

Kamiński B, Guzera Z. The unknown face of labial salivary glands. Labial salivary gland biopsy as a diagnostic tool. Medical Studies. 2019;35:172-179.

Błochowiak K, Sokalski J. Labial salivary gland biopsy in the diagnosis of Sjögren’s syndrome. Eur J Clin Exp Med. 2019;2:162-168. doi: 10.15584/ejcem.2019.2.10

Negrini S, Emmi G, Greco M, et al. Sjögren’s syndrome: a systemic autoimmune disease. Clin Exp Med. 2022;22(1):9-25. doi: 10.1007/s10238-021-00728-6

Zablotskyy O, Tomczyk M, Błochowiak K. Current recommendations for treatment and diagnosing of xerostomia in Sjögren’s syndrome. Eur J Clin Exp Med. 2019;17(4):356-363. doi: 10.15584/ejcem.2019.4.12

Baer AN, Walitt B. Update on Sjögren Syndrome and Other Causes of Sicca in Older Adults. Rheum Dis Clin North Am. 2018;44(3):419-436. doi: 10.1016/j.rdc.2018.03.002

Sebastian A, Dionizy P, Wiland P. IgG4-Related Disease and the Spectrum of Mimics in Rheumatology. Chronic autoimmune epithelitis. Sjögren’s syndrome and other autoimmune diseases of the exocrine glands. M. Maslinska (red.) IntechOpen Book Series Rheumatology, London; 2019: 73–85.

Kamiński B, Błochowiak K. Mikulicz’s disease and Küttner’s tumor as manifestations of IgG4-related diseases: A review of the literature. Reumatologia, 2020;58(4):243-250.

Wallace ZS, Naden RP, Chari S, et al. The 2019 American College of Rheumatology/European League against rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis, 2020;79(1):77-87.

Umehara H, Okazaki K, Masaki Y, et al. A novel clinical entity, IgG4-related disease (IgG4RD): general concept and details. Mod Rheumatol 2012;22:1-14. doi: 10.1007/s10165-011-0508-6

Umehara H, Okazaki K, Masaki Y, et al. Comprehensive diagnostic criteria for IgG4related disease (IgG4RD), 2011. Mod Rheumatol, 2012;22(1):21-30.

Tunnicliffe DJ, Singh-Grewal D, Kim S, Craig JC, Tong A. Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken). 2015;67(10):1440-1452. doi: 10.1002/acr.22591

Benli M, Batool F, Stutz C, Petit C, Jung S, Huck O. Orofacial manifestations and dental management of systemic lupus erythematosus: A review. Oral Dis. 2021;27(2):151-167. doi: 10.1111/odi.13271

Li BZ, Zhou HY, Guo B, et al. Dysbiosis of oral microbiota is associated with systemic lupus erythematosus. Arch Oral Biol. 2020;113:104708. doi: 10.1016/j.archoralbio.2020.104708

Bolton C, Chen Y, Hawthorne R, et al. Systematic Review: Monoclonal Antibody‑Induced Subacute Cutaneous Lupus Erythematosus. Drugs RD. 2020;20(4):319-330. doi: 10.1007/s40268-020-00320-5

Greco A, Marinelli C, Fusconi M, et al. Clinic manifestations in granulomatosis with polyangiitis. Int J Immunopathol Pharmacol. 2016;29(2):151-159. doi: 10.1177/0394632015617063

Szczeklik K, Włudarczyk A, Wawrzycka-Adamczyk K, et al. Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment. J Dent Sci. 2019;14(1):54-60. doi: 10.1016/j.jds.2018.10.004

Almouhawis HA, Leao JC, Fedele S, Porter SR. Wegener's granulomatosis: a review of clinical features and an update in Diagnosis and treatment. J Oral Pathol Med. 2013;42(7):507-516. doi: 10.1111/jop.12030

Faizan A, Bridget ES, Temitope O, Misha R. Oral Granulomatous Disease Dermatol Clin. 2020;38(4):429-439. doi: 10.1016/j.det.2020.05.004

Apoita-Sanz M, Blanco-Jauset P, Polis-Yanes C, et al. Granulomatosis with Poliangeitis (Wegener's Granulomatosis): Orofacial Manifestations. Systematic Review and Case Report. Oral Health Prev Dent. 2020;18(1):929-943. doi: 10.3290/j.ohpd.a45433

Barrett. AW. Wegener's granulomatosis of the major salivary glands. J Oral Pathol Med. 2012;41(10):721-727. doi: 10.1111/j.1600-0714.2012.01141.x

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Published

2023-09-30

How to Cite

Lin, S.-Y., Huang, Y.-W., & Błochowiak, K. (2023). Autoimmune diseases and their various manifestations in the oral cavity – a systematic review. European Journal of Clinical and Experimental Medicine, 21(3), 627–638. https://doi.org/10.15584/ejcem.2023.3.16

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REVIEW PAPERS