Q. What Causes and Heals Mouth Sores in Arthritis Patients?

• What can cause mouth sores in arthritis patients?
• Can any medication cause mouth sores or is it more common with certain medications?
• Are there other reasons for mouth sores (i.e. dry mouth in Sjogren's syndrome)?
• What treatments help eliminate mouth sores?
• Are there any preventative measures one can take?

What Causes Mouth Sores?

Oral ulcers or mouth sores develop on the palate, under the inside of the lips or inside of the cheeks. They are not uncommon in patients with arthritis due to medications. For example, medications which often cause mouth sores to develop include:

• NSAIDs
• methotrexate

What Treatments Help Relieve Mouth Sores?

In patients on methotrexate, taking daily folic acid, 1 mg or greater may reduce the incidence of mouth sores. If the problem persists, folinic acid (leukovorin) taken 8-12 hours after methotrexate may help without affecting the efficacy of methotrexate.

In patients who develop mouth sores on NSAIDs, consider switching to another NSAID or different therapy. Other treatments which may work to heal or prevent mouth sores include:

• supplemental folic acid (have your vitamin B12 checked as increased folic acid may mask occult B12 deficiency)
• yogurt
• acidophilus

Local steroid therapy such as kenalog in orabase may help for a few ulcers, while a combination of dexamethasone/benadryl/maalox in a 1/1/1 solution (swish and spit out) may ease the symptoms of multiple ulcers and help healing.

What Other Arthritis-Related Conditions Can Cause Mouth Sores?

Oral ulcers may also be a sign of lupus and reactive arthritis. The ulcers associated with lupus are typically painless.

Related Resources

• Methotrexate for Rheumatoid Arthritis
• The Facts of NSAIDs
• Test Your Knowledge: Arthritis Medications

_{Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read our review of the book.}