Autoimmune Diseases
Lupus erythematosus is a chronic inflammatory auto immune disease with a variable spectrum of clinical forms, in which mucocutaneous clinical manifestations may occur in association with or without multiple organ systems involvement.
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Autoimmune Diseases
Lupus Erythematosus Definition
.. Lupus erythematosus is a chronic inflammatory autoimmune disease with a variable spectrum of clinical forms, in which mucocutaneous clinical manifestations may occur in association with or without multiple organ systems involvement.
Etiology
.. It is thought that a genetically susceptible autoimmune mechanism triggered by environmental factors is responsible for the pathogenesis of the disease.
Classification
Gingival Involvement
.. The disease is classified into two major forms: • Discoid . • Systemic. .. Rare .. Non-dental plaque-induced gingival lesions
Other Involvement
.. Oral mucosa (15 % - 25 % in discoid form and 30 % - 45 % in systemic form) .. Other mucosae (conjunctiva, nose. genital) .. Skin .. Other organ systems (kidney, cardiovascular system, neurological system. joints)
Main Clinical Features
.. The gingival lesions may appear either as localized erythema, usually associated with erosions that may occasionally mimic desquamative gingivitis (Figs. 289,290 ). Less frequently lupus erythematosus may present as a non-specific painful ulceration surrounded by whitish spots or lines (Fig. 291 ). .. The oral mucosa lesions appear as well-defined atrophic red plaques usually surrounded by a sharp elevated border of radiating whitish striae. Erosions, atrophy. telangiectasias, white plaques and xerostomia may also occur. .. The skin lesions are characterized by flat or slightly elevated erythematous papules and plaques with scaling and follicular hyperkeratosis. Many patients in both forms develop the classic "butterfly" rash on the face. .. Systemic lupus erythematosus is characterized by a broad spectrum of clinical and laboratory diagnostic criteria. Constitutional symptoms include fatigue. malaise. fever and weight loss associated with arthralgia and myalgia.
G. Laskaris et al., Periodontal Manifestations of Local and Systemic Diseases © Springer-Verlag Berlin Heidelberg 2003
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Chapter 23 • Autoimmune Diseases FIGURE 289
Lupus erythematosus. Irregular erythema and erosions as early lesions on the gingiva
FIGURE 290
Lupus erythematosus. Erosions on the gingiva
FIGURE 291
Lupus erythematosus. Localized erosions on the gingiva
Chapter 23 • Autoimmune Diseases
Diagnosis
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Differential Diagnosis
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Treatment
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The clinical diagnosis should be confirmed by laboratory tests. Biopsy and histopathological examination of oral and skin lesions. Direct and indirect immunofluorescence. Lichen planus Cicatricial pemphigoid Bullous pemphigoid Linear IgA disease Pemphigus Mixed connective tissue disease Good dental plaque control. Topical corticosteroids. Antimalarials. Systemic corticosteroids. The treatment of systemic lupus erythematosus should be left to the specialist.
Sjogren's Syndrome Definition
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Sjogren's syndrome is a relatively common, chronic autoimmune disorder. The disease is more common in women between 40 and 60 years of age.
Etiology
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Obscure. However, genetic factors, viral infection and
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