Methotrexate-induced oral mucositis in rheumatoid arthritis disease: therapeutic strategy in a case report

Objective: The aim of this case report is to evaluate the efficacy of low-level laser therapy (LLLT) in the treatment of oral mucositis induced by methotrexate (MTX). M ethods: A 52-year-old male patient, affected by rheumatoid arthritis and treated with corticosteroids and MTX, complained about severe oral pain and lesions for two months. He had been treated with topical and systemic corticosteroid therapy and chlorhexidine rinses with no significant improvement. He was not able to eat solid food or to wear his dental prosthesis. Examination of the oral cavity revealed retro-commissural and labial bilateral ulcerations and erythema and a 2-cm wide fibrous white lesion on the lower anterior vestibular ridge. Blood tests showed mild pancytopenia, and oral biopsies evidenced a “ non-specific inflammatory condition ” excluding any precancerous or paraneoplastic lesion or autoimmune diseases of the oral cavity. Previous medical records revealed that MTX had been discontinued many times due to mucositis since 2006, when the therapy had been started. This suggested a correlation between the onset of oral mucositis and MTX accumulation. LLLT was carried out for 4 consecutive days and three once-a-week followups were performed. R esults: Lesions had completely healed during the second follow-up and the patient referred no pain at all from the 4th laser session on, therefore, the discontinuation of MTX had not been necessary. C onclusion: LLLT could represent an innovative technique to relieve pain related to MTX side effects thus avoiding dangerous discontinuation of therapy.