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Owrzodzenia w jamie ustnej a choroby reumatoidalne

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Schorzenia o podłożu reumatycznym mogą się objawiać za pośrednictwem wrzodziejących zmian w jamie ustnej. Prawidłowa diagnostyka tych symptomów może ułatwić wczesne rozpoznanie i skuteczne leczenie.

Toczeń rumieniowaty układowy

Jednym z objawów tocznia rumieniowatego układowego mogą być nadżerki błony śluzowej jamy ustnej i nosa. Zmiany przybierają także formę powierzchownych owrzodzeń, które mogą ulegać bliznowaceniu. Najczęściej nie powodują dolegliwości bólowych. Eksperci zwracają uwagę, że zmiany na błonach śluzowych jamy ustnej są szczególnie istotne w procesie diagnozowania skórnej postaci tocznia (tzw. toczeń krążkowy).


W przebiegu łuszczycy mogą występować nie tylko charakterystyczne objawy skórne, ale także zmiany w obrębie jamy ustnej. Objaw ten nie jest częsty, jednak w niektórych przypadkach może stanowić wyłączną zewnętrzną manifestację łuszczycy.

Zmiany łuszczycowe najczęściej rozwijają się na grzbiecie języka i błonie śluzowej policzków oraz na wargach, rzadko natomiast obejmują podniebienie. Mogą mieć postać wyraźnie zaznaczonych białawych blaszek o uniesionych brzegach, a także ciemnoczerwonych plam z szarobiałym nalotem. W niektórych przypadkach obserwuje się także zmiany rumieniowe i nadżerki.

Choroba Leśniowskiego-Crohna

Zmiany w jamie ustnej mogą znacznie wyprzedzać pojawienie się uszkodzeń jelitowych w przebiegu choroby Leśniowskiego-Crohna i przypominają je wyglądem. Zmiany przyjmują najczęściej formę kraterowatych, podłużnych owrzodzeń, aft, nadżerek i stwardnień. Mogą z nimi współwystępować zakażenia grzybicze błony śluzowej jamy ustnej oraz zanikowe zapalenia i obrzęki.

Układowe zapalenia naczyń

Zmiany w obrębie jamy ustnej są charakterystyczne dla choroby Behceta oraz ziarniniakowatości z zapaleniem naczyń. W przypadku choroby Behceta przyjmują one postać owrzodzeń i aft, które mogą występować na wargach, dziąsłach, policzkach i języku. Charakteryzują się powodowaniem nasilonych dolegliwości bólowych i goją się zazwyczaj bez tworzenia blizn.

W przebiegu ziarniniakowatości w obrębie błony śluzowej jamy ustnej, dziąseł i języka mogą się tworzyć charakterystyczne dla tej choroby owrzodzenia i nadżerki, którym towarzyszy znaczna bolesność.

Źródła: Sikorska D., Samborski W., „Jama ustna w reumatologii”, „Forum Reumatologiczne” 2016, 2 (2): 65-69.

Bronikowska-Kolasa A., Wojnowska D. et. al., „Łuszczyca błony śluzowej jamy ustnej i narządów płciowych”, „Nowa Medycyna” 2006, 1, 6-11.

Lembicz M., Batura-Gabryel H., Nowicka A., „Ziarniniakowatość z zapaleniem naczyń – obraz kliniczny i przegląd aktualnych opcji terapeutycznych”, „Pneumonologia i Alergologia Polska” 2014, 81: 61-73.

Przeczytaj także: Kraków: spektakularna replantacja ręki przeprowadzona z sukcesem

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