Autoimmune disease oral ulcers // Drug Repurposing

Autoimmune disease oral ulcers

Be immune-mediated or

Blisters arising in the mouth may be due to the autoimmune diseases, pemphigus and bullous pemphigoid. These are characterised by autoantibodies directed against the adhesion molecules of the skin and mucous membranes.

Oral pemphigus

Pemphigus is a term originally derived from the Greek term, pemphix, meaning bubble or blister.

It describes a group of blistering disorders characterised by antibodies directed against intercellular substance, which is found between epithelial cells (called keratinocytes in the skin). The antibodies cause the cells to separate from each other. Body fluid then fills the clefts to form blisters.

There are two main types of pemphigus than cause mucosal lesions:

Pemphigus vulgaris is the more common of the two, with an incidence of about 0.1 to 0.5 per 100, 000 of adult population. Pemphigus vulgaris is more common in patients of Ashkenazi Jewish descent and those of Mediterranean origin. Men and women are equally affected, with the mean age of onset being 50 to 60 years. However it may also affect children and the elderly.

Clinical presentation

Pemphigus vulgaris involves mucosal surfaces in 50-70% of patients. Oral vesicles (small blisters) are rarely seen intact as they break down rapidly and become shallow irregular erosions (sores) that later ulcerate. Widespread erosions may be seen, particularly over the buccal mucosa (inner aspect of cheeks) or palate. The gums may also be affected. These lesions may be sore and result in difficulty eating. Other mucosal surfaces i.e., the nose, eyelids, genitals and anus, may also be affected.

Paraneoplastic pemphigus typically first affects the lips first but may result in widespread oral erosions or lichenoid lesions (these are lesions that resemble oral lichen planus), and it may be severe. The discomfort makes eating and drinking difficult. This type of pemphigus is due to antibodies produced by a benign or malignant tumour. The most common benign tumour associated with paraneoplastic pemphigus is thymoma, followed by Castleman tumour, a rare and complex type of lymphoma. The most common associated malignant tumour (cancer) is non-Hodgkin lymphoma, followed by chronic lymphocytic leukemia.

What is the cause of pemphigus?

The cause of pemphigus remains unknown. However, there is a genetic predisposition and it is considered to be an autoimmune disorder. In 1964, autoantibodies against keratinocyte surfaces were described in patients with pemphigus.

Pemphigus sometimes occurs in patients that suffer from other autoimmune diseases, particularly myasthenia gravis and thymoma.

Pathological features

The characteristic histological findings in a biopsy of pemphigus are a split within the epidermis above the basal layer, with epithelial cells floating separately instead of being joined together. The basal cells stand like a row of tombstones on the floor of the blister at the base of the mucosa and epidermis.

A special test called direct immunofluorescence performed on the biopsy helps to confirm the diagnosis and differentiate pemphigus from other blistering disorders. A positive test indicates the presence of antibodies binding to the epithelial cell surface.

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Rheumatoid arthritis can be accompanied by another autoimmune disease called Sjogren's syndrome. Among other nasty things, it causes severe dry eyes, mouth, vag.
Sjogren's can occur on it's own, but is far more likely to accompany lupus or RA. If she doesn't have those, it is unlikely she has Sjogren's.
I had a big issue with dryness during pregnancy.
Bleeding during sex and severe bleeding during periods is something she should take up with her doctor. Good thing she's having regular visits with her ob/gyn.

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