ORAL MUCOSAL CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CALL FOR PREVENTIVE APPROACH.

Objectives: Oral mucosal lesions are important component of the diagnostic criteria of systemic lupus erythematosus (SLE). Relevant data has not yet been reported from Pakistan; hence this study was carried out to determine the frequency and types of oral lesions in relation to other clinical symptoms in patients with SLE while on treatment.
Methods: One hundred diagnosed SLE patients, attending a specialized treatment center at Lahore, were selected. Detailed history was recorded. Selective clinical and complete oral examination was carried out. Data was analyzed for statistical significance.
Results: Mean age of the patients was 28.54 ± 10.09 years with majority of the patients reporting in 21-35 years age group. Female to male ratio was 9:1. Most (51%) of the patients belonged to poor socioeconomic status. Positive family history was reported by 13% patients. Mean duration of disease was 4.87 ± 4.7 years. On history, photosensitivity (62%), recurrent painless oral (51%) and lip ulcers (31%) and metallic taste (1%) were reported. On clinical examination, arthritis (55%) followed by nephritis (53%), xerostomia (52%), glossitis (34%), gingival bleeding (32%), painless oral ulcers (24%), hair loss (23%), malar rash (15%) and skin lesions (12%) were observed. Age, socioeconomic status and skin lesions were strongly associated (p<0.05) with duration of disease (1-8 years). Xerostomia, mostly (44.2%) of moderate degree, was strongly associated with gingival bleeding (p=0.00), lip ulcers (p=0.028) and arthritis (p=0.013). Painless oral ulcers, commonest (42%) site being tongue, showed significant association with arthritis (p=0.024). Hair loss demonstrated significant relationship with glossitis (p=0.053), photosensitivity (p=0.020) and arthritis (p=0.011). No significant association was seen among other studied variables.
Conclusions: Oral lesions are quite prevalent in patients with SLE that highlights the importance of taking preventive measures to improve the oral health which subsequently will enhance the quality of life as well as compliance to drug therapy of these immunosuppressed patients.