IADR Abstract Archives
Clinicopathological study of MTX-LPD in the oral cavity
Objectives:
Since the late 1980s, Methotrexate (MTX) has become an anchor drug for rheumatoid arthritis (RA). The incidence of methotrexate-associated lymphoproliferative disorders (MTX-LPD) has recently increased. However, few studies have reported lesions in the oral cavity. We evaluated Japanese reports describing the clinical and pathological features of such lesions to clarify the clinical characteristics of MTX-LPD in the oral cavity.
Methods:
We treated three patients with MTX-LPD of the oral cavity who were referred to our department and subsequently performed a literature review of such cases. The review was performed using the website of the Japan Medical Abstracts Society and cross-referenced with the retrieved literature between 2008 and 2017 that included cases of MTX-LPD in the oral cavity.
Results: 42 cases of MTX-LPD in the oral cavity were gathered. Among the 42 patients (12 male; 30 female; average age, 69.1 years; range, 40-87 years) with MTX-LPD of the oral cavity, the most frequent site was the gingiva in 76.2% (32/42) and the most frequent symptom was ulceration. The Epstein-Barr virus (EBV) was detected in 97.6% (40/41) of patients. Spontaneous regression occurred in 85.7% (36/42) of patients who withdrew MTX. A literature search revealed that the occurrence of MTX-LPD in the oral cavity is associated with gingival ulceration, a high rate of EBV positivity, and a good response to MTX withdrawal.
Conclusions:
The number of reported patients with MTX-LPD has recently increased, although the mechanism of MTX-LPD remains unclear. Since the occurrence of MTX-LPD in the oral cavity is rare, awareness of the condition and appropriate diagnosis and management are necessary.
Since the late 1980s, Methotrexate (MTX) has become an anchor drug for rheumatoid arthritis (RA). The incidence of methotrexate-associated lymphoproliferative disorders (MTX-LPD) has recently increased. However, few studies have reported lesions in the oral cavity. We evaluated Japanese reports describing the clinical and pathological features of such lesions to clarify the clinical characteristics of MTX-LPD in the oral cavity.
Methods:
We treated three patients with MTX-LPD of the oral cavity who were referred to our department and subsequently performed a literature review of such cases. The review was performed using the website of the Japan Medical Abstracts Society and cross-referenced with the retrieved literature between 2008 and 2017 that included cases of MTX-LPD in the oral cavity.
Results: 42 cases of MTX-LPD in the oral cavity were gathered. Among the 42 patients (12 male; 30 female; average age, 69.1 years; range, 40-87 years) with MTX-LPD of the oral cavity, the most frequent site was the gingiva in 76.2% (32/42) and the most frequent symptom was ulceration. The Epstein-Barr virus (EBV) was detected in 97.6% (40/41) of patients. Spontaneous regression occurred in 85.7% (36/42) of patients who withdrew MTX. A literature search revealed that the occurrence of MTX-LPD in the oral cavity is associated with gingival ulceration, a high rate of EBV positivity, and a good response to MTX withdrawal.
Conclusions:
The number of reported patients with MTX-LPD has recently increased, although the mechanism of MTX-LPD remains unclear. Since the occurrence of MTX-LPD in the oral cavity is rare, awareness of the condition and appropriate diagnosis and management are necessary.