Oral mucositis as a result of the use of Methotrexate
DOI:
https://doi.org/10.35954/SM2019.38.1.7Keywords:
Autoimmune Diseases, Stomatitis, Infection, Methotrexate, Mucositis, UlcerAbstract
Methotrexate is a folic acid antimetabolite and an immunosuppressive agent. The folic acid synthesis inhibition reduces cell proliferation. It has been used to treat autoimmune diseases such as rheumatoid arthritis, or as part of chemotherapy against several types of cancer. Its use can produce a wide variety of adverse effects, among which we find Oral Mucositis. This constitutes a loss of the integrity of the mucosa, thus representing a gateway for microorganisms of the oral microflora, predisposing patients to infection, especially during periods of neutropenia. We describe two clinical cases: The first, is a female patient with a diagnosis of rheumatoid arthritis of 40 years of evolution. She was medicated with Methotrexate, showing several oral lesions and was referred to the family doctor with a presumptive diagnosis of Methotrexate mucositis. Twenty days after the drug was suspended, the evolution was favorable. The second clinical case is a female patient with a diagnosis of rheumatoid arthritis of 12 years of evolution, with oral ulcerative lesions, and a presumptive diagnosis of Methotrexate mucositis. She weas referred to her treating doctor and upon suspending the drug, the evolution was favorable in later controls. In order to treat and prevent mucositis, a wide variety of treatments have been used, most of them with conflicting results. The most significant are: lidocaine, rinses with chlorhexidine, chamomile, cryotherapy, corticosteroids, laser and vitamin E.
Downloads
References
(1) Horie N, Kawano R, Kaneko T, Shimoyama T. Methotrexate-related lymphoproliferative disorder arising in the gingival of a patient with rheumatoid arthritis. Aust Dent J 2015; 60(3):408-11. doi: 10.1111/adj.12235
(2) Knoll K, Anzengruber F, Cozzio A, French L, Murer C, Navarini A. Mucocutaneous Ulcerations an Pancytopenia due to Methotrexate Overdose. Case Rep Dermatol 2016; 8(3):287-293. doi: 10.1159/000446692
(3) Gori E, Arpinati M, Bonifazi F, Errico A, Mega A, Alberani F, et al. Cryotherapy in the prevention or oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group. Bone Marrow Transplant 2007; 39(6):347-52. doi: 10.1038/sj.bmT.1705590
(4) Katsoulas N, Chrysomali E, Piperi E, Levidou G, Sklavounou-Andrikopoulou A. Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare cirpofloxacin-induced case and review of the literature. J Clin Exp Dent 2016; 8(5):e629-33. doi: 10.4317/jced.52909
(5) Abeloff M, Armitage J, Niederhuber J, Kastan M, McKenna W. Abeloff's Clinical Oncology. 4th ed. Churchill Livingstone, 2008. 2592 p.
(6) Ruiz G, Nervi B, Vargas A, Maiz A. Tratamiento y Prevención de la mucositis Oral asociada al tratamiento del cáncer. Rev Med Chile 2011; 139(3):373-381. doi: 10.4067/S0034-98872011000300015
(7) Gautam A, Fernandes D, Vidyasagar M, Maiya A, Guddattu V. Low level laser therapy against radiation induced oral mucositis in elderly head and neck cancer patients randomized placebo controlled trial. J Photochem Photobiol B 2015; 144:51-6. doi: 10.1016/j.jphotobiol.2015.01.011
(8) Carneiro-Neto JN, de-Menezes JD, Moura LB, Massucato EM, de-Andrade CR. Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current. Med Oral Patol Oral Cir Bucal 2017; 22 (1):e15-e 23. doi: 10.4317/medoral.21314
(9) Lalla R, Bowen J, BaraschA,Elting L, Epstein J, KeefeD, et al. MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Cancer 2014; 120(10):1453-61. doi: 10.1002/cncr.28592
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 María Inés Araújo, Paola Piastra, Cecilia Colina. The author retains his copyright and assigns to the journal the right of first publication of his work, which will be simultaneously subject to the Creative Commons Attribution 4.0 International License that allows sharing the work as long as the initial publication in this journal is indicated.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Until 2024 we use the Creative Commons Attribution/NonCommercial Attribution 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/deed.es. Which states that: you are free to share, copy and redistribute the material in any medium or format, as well as to adapt, remix, transform and build upon the material. Under the following terms:
Attribution: you must give proper credit , provide a link to the license, and indicate if changes have been made . You may do so in any reasonable manner, but not in such a way as to suggest that you or your use is endorsed by the licensor.
NonCommercial: you may not use the material for commercial purposes.
As of 2025 authors retain their copyright and assign to the journal the right of first publication of their work, which shall simultaneously be subject to the license https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es that permits sharing, copying and redistribution of the material in any medium or format provided that initial publication in this journal is indicated. Adapt, remix, transform and build upon the material. If you remix, transform, or build from the material, you must distribute your contribution under the same license as the original and may not make use of the material for commercial purposes.
Under the following terms:
1. Attribution: you must give proper credit, provide a link to the license, and indicate whether changes have been made. You may do so in any reasonable manner, but not in such a way as to suggest that you or your use is endorsed by the licensor.
2. NonCommercial: you may not use the material for commercial purposes.
3. ShareAlike: if you remix, transform or build upon the material, you must distribute your contribution under the same license as the original.
PlumX Metrics
