Great thread 👇
We (rheumatologist) usually see lot of referrals for recurrent Mucositis
Most of them have recieved multiple oral vitamins and paste and oral steroids atleast
What I have found in our clinic
Systematic disease patients often have ma my other clues, which is often easy to elicit, start asking. For eg an SLE patient with palatal ulcer may have many other clues like other rash / female sex / youngish age / Arthralgias / leukopenia
Also remember that not all differentials can be proven by blood tests
Eg oral lichen Planus or behcets or a malignancy or Crohn’s disease
Chronic alcohol and smoking are really significant perpetrators in many
Iron deficiency is single most important vitamin probably after b12 which needs good dosing or parental infusion - 7 out of 10 patients referred to us improve with iron. They are often referred because doctors often fail to recognise or treat iron deficiency with or without anemia adequately
Recurrent Apthous stomatitis though often invoked by us, there are very few patients who are really refractory. We had one such patient with hepatitis b and under treatment. Had to give regular infliximab and after 2 years evolved to behcets with occurrence of genital ulcers. Hla b51 was negative and there was no other clear semiology to suggest Behcets. Also recieved at-least 10 other drugs before infliximab including colchicine, dapsone, thalidomide, etc. So even if we think of differentials, diseases may take time to evolve.
Lastly in rheumatology we see lot of sjogren disease with oral Sicca. Their mucosa is often red and inflamed and under recognition often leads to unnecessary blame on methotrexate / deficiencies / sulfasalazine and they suffer. Timely understanding / use of antifungals for superadded candid infection and use of drugs like oral pilocarpine, salivary substitutes can really be helpful.
A patient with “recurrent mouth ulcers” walks into your OPD
Most get symptomatic treatment
Few get evaluated properly
And almost everyone assumes
“Mouth ulcers = vitamin deficiency”
Reality?
Recurrent aphthous stomatitis is primarily a T-cell mediated disease
Let’s decode what we’re actually missing 👇