Oral soft tissue manifestations in patients with rheumatoid arthritis undergoing antirheumatic therapy: a scoping review.

This study aimed to describe and evaluate the available evidence on oral soft tissue manifestations in individuals with RA receiving antirheumatic therapy, highlighting clinical patterns, implicated drugs, and existing knowledge gaps. A scoping review was conducted through comprehensive searches in PubMed, Scopus, Web of Science, Embase, and LILACS, complemented by gray literature. Eligible studies included observational and interventional designs that assessed oral soft tissue manifestations related to the use of antirheumatic agents in RA. Data were extracted and summarized descriptively according to study design and clinical outcomes. Fourteen studies comprising 4446 RA patients were included, of whom 3452 were females (77.6%), predominantly aged 40-60 years. Methotrexate was the most frequently used agent, followed by leflunomide, sulfasalazine, hydroxychloroquine, and corticosteroids. Oral ulcers were the most prevalent oral soft tissue manifestation, reported in 406 instances (9.13%), typically occurring during methotrexate therapy, with variable duration and distribution. Xerostomia was reported in 87 patients (1.95%), and 28 (0.6%) episodes of stomatitis were identified particularly among patients using multiple disease-modifying antirheumatic drugs. In most studies, lesions were mild and managed symptomatically, without discontinuation of therapy. In summary, oral manifestations represent clinically relevant yet underrecognized adverse effects of antirheumatic therapy in RA. Strengthening collaboration between rheumatologists and oral medicine specialists is crucial for early recognition, accurate differential diagnosis, and prevention of severe outcomes.