Tuesday, December 14, 2010

Patient With Rheumatoid Arthritis Develops Dental Caries

A patient with rheumatoid arthritis presents to her physician and mentions that after many years without teeth problems, she has recently developed seven caries. This is a clue to her clinician that she should be evaluated for which of the following diseases? 

           A. Oral squamous cell carcinoma 
           B. Polyarteritis nodosa 
           C. Sjögren's syndrome 
           D. Systemic lupus erythematosus 
           E. Thyrotoxicosis 


      The correct answer is C. Rheumatoid arthritis can coexist with a variety of autoimmune diseases (including those listed in the answers), but is most frequently associated with Sjögren's syndrome. Sjögren's syndrome is due to autoimmune involvement with subsequent scarring of the salivary and lacrimal glands, leading to dry eyes and dry mouth. Secondary effects include parotid gland enlargement, dental caries, and recurrent tracheobronchitis. 

      Squamous cell carcinoma of the mouth (choice A) is not associated with dryness of the mouth. 

      Polyarteritis nodosa (choice B) is a systemic necrotizing vasculitis. Patients present with low-grade fever,weakness, and weight loss. They may also have abdominal pain, hematuria, renal failure, hypertension, and leukocytosis. 

      Systemic lupus erythematosus (choice D) is an autoimmune disease characterized by vasculitis (which may produce a variety of symptoms depending on the site of the lesion), rash, renal disease, hemolytic anemia, and neurologic disturbances. 

      Thyrotoxicosis (choice E) produces insomnia, weight loss, tremors, heat intolerance, excessive sweating, and frequent bowel movements or diarrhea.