Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지
DOI QR코드

DOI QR Code

Methotrexate-induced Oral Mucositis

  • Lee, Hye-Jin (Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentisty) ;
  • Kwon, Jeong-Seung (Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentisty) ;
  • Choi, Young-Chan (Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentisty) ;
  • Ahn, Hyung Joon (Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentisty)
  • Received : 2015.03.30
  • Accepted : 2015.04.27
  • Published : 2015.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Methotrexate (MTX) is a chemotherapeutic agent that is used to treat a host of malignancies. But recently, MTX has also been used as a therapeutic agent for chronic inflammatory disorders such as rheumatoid arthritis, psoriasis, and systemic lupus erythematosus. However, MTX is an antimetabolite that affects rapidly dividing normal cells such as oral mucosal epithelial cells, gastrointestinal epithelial cells, and bone marrow cells-which explains why oral mucositis is often an initial manifestation of MTX toxicity. Because oral lesions are frequently initially presented in dental clinics, dentists should consider the possibility of adverse drug reactions in the differential diagnoses of oral lesions through a meticulous collection of patients' medical histories. In this report, we examine patients who suffered from oral ulcerative lesions upon diagnosis of MTX-induced oral mucositis. Then, we suggest approaches for the diagnosis and treatment of MTX-induced oral mucositis through a review of literature.

Keywords

References

  1. Kremer JM. Toward a better understanding of methotrexate. Arthritis Rheum 2004;50:1370-1382. https://doi.org/10.1002/art.20278
  2. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol 2014;10:1519-1530. https://doi.org/10.1586/1744666X.2014.962996
  3. Czarnecka-Operacz M, Sadowska-Przytocka A. The possibilities and principles of methotrexate treatment of psoriasis: the updated knowledge. Postepy Dermatol Alergol 2014;31:392-400.
  4. Sakthiswary R, Suresh E. Methotrexate in systemic lupus erythematosus: a systematic review of its efficacy. Lupus 2014;23:225-235. https://doi.org/10.1177/0961203313519159
  5. Bremer JP, Ullrich S, Laudien M, Gross WL, Lamprecht P. Methotrexate plus leflunomide for the treatment of relapsing Wegener's granulomatosis. A retrospective uncontrolled study. Clin Exp Rheumatol 2010;28(1 Suppl 57):67-71.
  6. Turner D, Doveh E, Cohen A, et al. Efficacy of oral methotrexate in paediatric Crohn's disease: a multicentre propensity score study. Gut 2014. doi: 10.1136/gutjnl-2014-307964. [Epub ahead of print]
  7. Kodama Y, Fukano R, Noguchi M, Okamura J, Inagaki J. Folinic acid after MTX as prophylaxis for GVHD in pediatric bone marrow transplantation. Int J Hematol 2015;101:92-98. https://doi.org/10.1007/s12185-014-1712-x
  8. Tian H, Cronstein BN. Understanding the mechanisms of action of methotrexate: implications for the treatment of rheumatoid arthritis. Bull NYU Hosp Jt Dis 2007;65:168-173.
  9. Cronstein BN, Naime D, Ostad E. The antiinflammatory mechanism of methotrexate. Increased adenosine release at inflamed sites diminishes leukocyte accumulation in an in vivo model of inflammation. J Clin Invest 1993;92:2675-2682. https://doi.org/10.1172/JCI116884
  10. van Ede AE, Laan RF, Blom HJ, De Abreu RA, van de Putte LB. Methotrexate in rheumatoid arthritis: an update with focus on mechanisms involved in toxicity. Semin Arthritis Rheum 1998;27:277-292. https://doi.org/10.1016/S0049-0172(98)80049-8
  11. Bauer J, Fartasch M, Schuler G, Schell H. Ulcerative stomatitis as clinical clue to inadvertent methotrexate overdose. Hautarzt 1999;50:670-673. https://doi.org/10.1007/s001050050979
  12. Troeltzsch M, von Blohn G, Kriegelstein S, et al. Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e28-e33.
  13. Kivity S, Zafrir Y, Loebstein R, Pauzner R, Mouallem M, Mayan H. Clinical characteristics and risk factors for low dose methotrexate toxicity: a cohort of 28 patients. Autoimmun Rev 2014;13:1109-1113. https://doi.org/10.1016/j.autrev.2014.08.027
  14. Park GT, Jeon DW, Roh KH, et al. A case of pancytopenia secondary to low-dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiency. Korean J Intern Med 1999;14:85-87. https://doi.org/10.3904/kjim.1999.14.1.85
  15. Kalantzis A, Marshman Z, Falconer DT, Morgan PR, Odell EW. Oral effects of low-dose methotrexate treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:52-62. https://doi.org/10.1016/j.tripleo.2004.08.020
  16. Thumboo J, Koh WH, Leong KH, Boey ML, Feng PH. The safety of weekly low dose oral methotrexate in an Oriental population with rheumatoid arthritis. Ann Acad Med Singapore 1997;26:205-209.
  17. Ranchon F, Vantard N, Gouraud A, et al. Suspicion of drug-drug interaction between high-dose methotrexate and proton pump inhibitors: a case report: should the practice be changed? Chemotherapy 2011;57:225-229. https://doi.org/10.1159/000327372
  18. Schnabel A, Gross WL. Low-dose methotrexate in rheumatic diseases:efficacy, side effects, and risk factors for side effects. Semin Arthritis Rheum 1994;23:310-327. https://doi.org/10.1016/0049-0172(94)90027-2
  19. Shea B, Swinden MV, Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev 2013;5:CD000951.

Cited by

  1. Stratification of methotrexate‐induced oral ulcers in rheumatoid arthritis patients vol.41, pp.3, 2015, https://doi.org/10.1111/scd.12575