title: Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review.
abstract: BACKGROUND
  The differential diagnosis of ulcerative oral lesions is diverse. This report discusses the rare causes of oral mucosal ulceration and suggests approaches for diagnosis and treatment.
  
  
  METHODS
  Two cases of methotrexate-induced stomatitis in patients receiving low dose methotrexate for rheumatoid arthritis are presented with a review of the current literature. In case 1, mucositis was caused by an unintended methotrexate overdose. In case 2, oral lesions were the result of chronic methotrexate toxicity. The treatment for methotrexate-induced mucositis required hospitalization in case 1, methotrexate discontinuation in both cases and oral folic acid supplementation in case 2.
  
  
  RESULTS
  In both cases, the mucositis healed and no relapse was observed.
  
  
  CONCLUSIONS
  Mucositis may be an early sign of systemic conditions, and dental providers are often the first doctors involved in the assessment of oral mucosal diseases. Meticulous questioning of the patient's history and the physical examination is important for elucidating the underlying cause.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ansbach General Hospital, Ansbach, Germany. matthias_troeltzsch@hotmail.com
authors.forename: Matthias
authors.initials: M
authors.lastname: Troeltzsch
authors.forename: Gerhard
authors.initials: G
authors.lastname: von Blohn
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kriegelstein
authors.forename: Timothy
authors.initials: T
authors.lastname: Woodlock
authors.forename: Volker
authors.initials: V
authors.lastname: Gassling
authors.forename: Ronald
authors.initials: R
authors.lastname: Berndt
authors.forename: Markus
authors.initials: M
authors.lastname: Troeltzsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000506:poisoning; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000150:complications; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005500:Follow-Up Studies; D005892:Gingivitis, Necrotizing Ulcerative / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D008047:Lip Diseases / Q000139:chemically induced; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000506:poisoning; D019226:Oral Ulcer / Q000139:chemically induced*; D012883:Skin Ulcer / Q000139:chemically induced; D013280:Stomatitis / Q000139:chemically induced*; D013283:Stomatitis, Herpetic / Q000175:diagnosis; D014060:Tongue Diseases / Q000139:chemically induced
chemical_list: D018501:Antirheumatic Agents; D005492:Folic Acid; D008727:Methotrexate