A patient with rheumatoid ahritis mentions to her physician that after many years without dental problems, she has recently had seven dental caries filled. This finding suggests that she should be evaluated for which of the following diseases?
Rheumatoid ahritis can coexist with a variety of autoimmune diseases (including those listed in the answers), but is most frequently associated with Sjogren's syndrome. Sjogren's syndrome classically presents with keratoconjunctivitis (dry eyes) and xerostomia (dry mouth, often resulting in dental caries and fissures in the oral mucosa). These symptoms are due to autoimmune involvement with subsequent scarring of the salivary and lacrimal glands. Parotid gland enlargement is common, as is vasculitis, Raynaud's phenomenon, hyperviscosity syndrome, and peripheral neuropathy. The development of oral squamous cell carcinoma is not related to the presence of dental caries. Polyaeritis nodosa is a systemic necrotizing vasculitis. Patients typically present with low-grade fever, weakness, and weight loss. Abdominal pain, hematuria, renal failure, hypeension, and leukocytosis may occur. Systemic lupus erythematosus is an autoimmune disease characterized by vasculitis, rash, renal disease, hemolytic anemia, and neurologic disturbances. Ref: O'Dell J.R., Imboden J.B., Miller L.D. (2013). Chapter 15. Rheumatoid Ahritis. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Diagnosis & Treatment: Rheumatology, 3e.
Oral squamous cell carcinoma
Polyaeritis nodosa
Sjogren's syndrome
Systemic lupus erythematosus