Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a multisystem
disorder of small blood vessels subdivided into granulomatosis with polyangiitis (GPA),
microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis
(EGPA). Oral manifestations (OMs) have been reported to include mucosal ulceration,
gingival enlargement, alveolar bone necrosis, tooth loss, oro-antral communication,
palatal perforation, parotitis, and candidal infection mainly in GPA. They may appear
during the course of the disease, as a disease flare-up, or as the presenting sign.
These OMs are often nonspecific and can mimic an array of conditions, therefore formulating
a differential diagnosis can be challenging. This review updates the OMs of GPA, and,
for the first, time includes OMs of other AAVs. It provides recommendations for the
overall assessment and the diagnosis and management of all AAV OMs with considerations
for treatment coordination. The role of oral health care providers in multidisciplinary
care is highlighted.
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REFERENCES
- 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides.Arthritis Rheum. 2013; 65: 1-11
- Vasculitis syndrome-diagnosis and therapy.J Gen Fam Med. 2017; 18: 72-78
- Introduction, epidemiology and classification of vasculitis.Best Pract Res Clin Rheumatol. 2018; 32: 3-20
- COVID-19 vasculitis and novel vasculitis mimics.Lancet Rheumatol. 2021; 3: e224-e233
- Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis.Springer, Chaim, Switzerland2020
- Pathogenesis of ANCA-associated vasculitis: an emerging role for immunometabolism.Rheumatology (Oxford). 2020; 59: iii33-iii41
- Vasculitis update: pathogenesis and biomarkers.Pediatr Nephrol. 2018; 33: 187-198
- Management of ANCA associated vasculitis.BMJ. 2020; 368: m421
- An update on the epidemiology of ANCA-associated vasculitis.Rheumatology (Oxford). 2020; 59: iii42-iii50
- Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.Nephrol Dial Transplant. 2015; 30: i14-i22
- The epidemiology of antineutrophil cytoplasmic autoantibody-associated vasculitis in Olmsted County, Minnesota: a twenty-year US population-based study.Arthritis Rheumatol. 2017; 69: 2338-2350
- Incidence of ANCA-associated vasculitis in a UK mixed ethnicity population.Rheumatology (Oxford). 2016; 55: 1656-1663
- Proteinase-3 and myeloperoxidase serotype in relation to demographic factors and geographic distribution in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis.Nephrol Dial Transplant. 2019; 34: 301-308
- Environmental risk factors associated with ANCA associated vasculitis: a systematic mapping review.Autoimmun Rev. 2020; 19102660
- ANCA-associated vasculitis: pathogenesis, models, and preclinical testing.Semin Nephrol. 2017; 37: 418-435
- Genetically distinct subsets within ANCA-associated vasculitis.N Engl J Med. 2012; 367: 214-223
- How anti-neutrophil cytoplasmic autoantibodies activate neutrophils.Clin Exp Immunol. 2012; 169: 220-228
- Proteinase 3: the odd one out that became an autoantigen.J Leukoc Biol. 2017; 102: 689-698
- Overview of the pathogenesis of ANCA-associated vasculitis.Kidney Dis (Basel). 2015; 1: 205-215
- Pathogenesis of ANCA-associated vasculitis: an update.Autoimmun Rev. 2016; 15: 704-713
- Pathogenesis of antineutrophil cytoplasmic autoantibody-mediated disease.Nat Rev Rheumatol. 2014; 10: 463-473
- Netting neutrophils in autoimmune small-vessel vasculitis.Nat Med. 2009; 15: 623-625
- Alternative complement pathway in the pathogenesis of disease mediated by anti-neutrophil cytoplasmic autoantibodies.Am J Pathol. 2007; 170: 52-64
- Antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase cause glomerulonephritis and vasculitis in mice.J Clin Invest. 2002; 110: 955-963
- Granulomatous inflammation in ANCA-associated vasculitis.Int J Mol Sci. 2021; 22: 6474
- ANCA-associated vasculitis: an update.J Clin Med. 2021; 10: 1446
- Lung involvement in ANCA-associated vasculitis.Presse Med. 2020; 49104039
- ANCA-associated vasculitis with renal involvement.J Nephrol. 2018; 31: 197-208
- Cutaneous manifestations of ANCA-associated small vessels vasculitis.Clin Rev Allergy Immunol. 2017; 53: 428-438
- Vasculitis and peripheral neuropathy.Curr Opin Rheumatol. 2019; 31: 40-45
- Updates in ANCA-associated vasculitis.Eur J Rheumatol. 2016; 3: 122-133
- Gingival lesions in a 21-year-old man.J Am Dent Assoc. 2012; 143: 253-258
- Oral manifestations of granulomatosis with polyangiitis—clinical and radiological assessment.J Dent Sci. 2019; 14: 54-60
- From strawberry gingivitis to palatal perforation: the clinicopathological spectrum of oral mucosal lesions in granulomatosis with polyangiitis.J Oral Pathol Med. 2020; 49: 443-449
- Gingival swelling as the initial manifestation of granulomatosis with polyangiitis.Head Neck Pathol. 2021; 15: 244-253
- Oral ulcers and its relevance to systemic disorders.Aliment Pharmacol Ther. 2005; 21: 295-306
- ANCA-associated vasculitis—ENT involvement.in: Sinico R Guillevin L Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis. Rare Diseases of the Immune System. Springer, Cham2020: 147-161
- Granulomatosis with poliangeitis (Wegener's granulomatosis): orofacial manifestations. Systematic review and case report.Oral Health Prev Dent. 2020; 18: 929-943
- Gingival hyperplasia as first sign of recurrence of granulomatosis with polyangiitis (Wegener's granulomatosis): case report and review of the literature.BMC Oral Health. 2016; 17: 33
- Strawberry gingival hyperplasia: a pathognomonic mucocutaneous finding in Wegener granulomatosis.Arch Dermatol. 2000; 136: 171-173
- Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease.Aust Dent J. 2017; 62: 102-106
- Strawberry gingivitis: challenges in the diagnosis of granulomatosis with polyangiitis on gingival specimens.Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128: e202-e207
- Oral granulomatous disease.Dermatol Clin. 2020; 38: 429-439
- Granulomatous reaction to hyaluronic acid filler material in oral and perioral region: a case report and review of literature.J Cosmet Dermatol. 2018; 17: 578-583
- Granulomatous diseases: oral manifestations and recommendations.Saudi Dent J. 2020; 32: 219-223
- Onset and progression of clinical manifestations of orofacial granulomatosis.Oral Dis. 2009; 15: 214-219
- Oral manifestations of Crohn's disease: a case report and review of the literature.Case Rep Dent. 2015; 2015830472
- Oral ulceration as a presenting sign of unknown sarcoidosis mimicking a tumour: report of 2 cases.Oral Oncol. 1998; 34: 427-430
- Orofacial tuberculosis: clinical manifestations, diagnosis and management.J Family Med Prim Care. 2015; 4: 335-341
- Oral histoplasmosis.Head Neck Pathol. 2017; 11: 513-516
- A case report of a tongue ulcer presented as the first sign of occult tuberculosis.BMC Oral Health. 2019; 19: 67
- Hodgkin's lymphoma with marked granulomatous reaction: a diagnostic pitfall.Int J Clin Exp Pathol. 2019; 12: 2772-2774
- Granuloma formation clinically presenting as erythroderma in a patient with peripheral T-cell lymphoma.Eur J Dermatol. 2019; 29: 324-326
- Non-neoplasic and non-syndromic palatal perforations. Presentation of 5 cases and systematic review of the literature.J Clin Exp Dent. 2021; 13: e961-e968
- Palatal perforations: past and present. Two case reports and a literature review.Br Dent J. 2005; 199: 267-269
Tungare S, Paranjpe AG. Drug induced gingival overgrowth. 2021 Sep 25. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538518/#_NBK538518_pubdet_.
- Leukaemic infiltration in the oral and maxillofacial region: an update.J Oral Pathol Med. 2021; 50: 558-564
- Behcet's disease: review with emphasis on dermatological aspects.An Bras Dermatol. 2017; 92: 452-464
- ANCA-associated vasculitis: advancement in pathogenesis, clinical features and management.Biomed J Sci & Tech Res. 2019; 21: 15813-15819
- The clinical and pathological features of children with microscopic polyangiitis.Front Pediatr. 2021; 9645785
- Oral lesions as the first clinical sign of microscopic polyangiitis: a case report.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 707-711
- Oral ulceration: an unusual manifestation of Churg–Strauss syndrome.J Eur Acad Dermatol Venereol. 2007; 21: 969-972
- FRI0453 damage accrual in patients with eosinophilic granulomatosis with polyangiitis (EGPA): analysis of 53 patients.Ann Rheum Dis. 2014; 73: 551
- Multiple oral ulcerations: a very rare case of Churg-Strauss syndrome with renal disease.J Oral Maxillofac Surg Med Pathol. 2018; 30: 175-179
- Refractory oral ulcers in eosinophilic granulomatosis with polyangiitis.J Dermatol. 2019; 46: e377-e378
- Eosinophilic granulomatosis with polyangiitis and oral lesions: an atypical first sign of the disease. A literature review.J Osseointegr. 2021; 13: 43-46
- Classification, diagnosis and treatment of ANCA-associated vasculitis.World J Rheumatol. 2015; 5: 36-44
- Clinical associations of renal involvement in ANCA-associated vasculitis.Autoimmun Rev. 2020; 19102495
- ANCA-associated vasculitis—clinical utility of using ANCA specificity to classify patients.Nat Rev Rheumatol. 2016; 12: 570-579
- Occurrence and antigenic specificity of perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) in systemic autoimmune diseases.Cells. 2021; 10: 2128
- Serum ANCA as disease biomarkers: clinical implications beyond vasculitis.Clin Rev Allergy Immunol. 2022; 63: 107-123
- 2020 international consensus on ANCA testing beyond systemic vasculitis.Autoimmun Rev. 2020; 19102618
- Association of ANCA associated vasculitis and rheumatoid arthritis: a lesser recognized overlap syndrome.Springerplus. 2015; 4: 50
- Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in patients with biopsy-proven glomerulonephritis.Medicine (Baltimore). 2016; 95: e3748
- Revisiting ANCA-associated vasculitis in systemic sclerosis: clinical, serological and immunogenetic factors.Rheumatology (Oxford). 2013; 52: 1824-1831
- ANCA-associated vasculitis in patients with primary Sjögren's syndrome: detailed analysis of 7 new cases and systematic literature review.Autoimmun Rev. 2015; 14: 742-750
- Vasculitis in patients with inflammatory bowel diseases: a study of 32 patients and systematic review of the literature.Semin Arthritis Rheum. 2016; 45: 475-482
- Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study.Rheumatology (Oxford). 2011; 50: 2035-2043
- Infections and antineutrophil cytoplasmic antibodies: triggering mechanisms.Autoimmun Rev. 2015; 14: 201-203
- Antineutrophil cytoplasmic antibodies associated with infective endocarditis.Medicine (Baltimore). 2016; 95: e2564
- High prevalence of a variety of autoantibodies in a population of hepatitis C virus-infected individuals.APMIS. 2018; 126: 515-522
- Antineutrophil cytoplasmic antibody frequency in chronic hepatitis B patients.Dis Markers. 2014; 2014982150
- Could Sars-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects?.Autoimmun Rev. 2020; 19102524
- ANCA-associated vasculitis after COVID-19.Rheumatol Int. 2021; 41: 1523-1529
- De novo ANCA-associated vasculitis with glomerulonephritis in COVID-19.Kidney Int Rep. 2020; 5: 2079-2083
- Newly diagnosed glomerulonephritis during COVID-19 infection undergoing immunosuppression therapy, a case report.Iran J Kidney Dis. 2020; 14: 239-242
- Antineutrophil cytoplasmic antibody-associated glomerulonephritis in a case of scleroderma after recent diagnosis with COVID-19.Cureus. 2021; 13: e12485
- Clinical and immunological features of drug-induced and infection-induced proteinase 3-antineutrophil cytoplasmic antibodies and myeloperoxidase-antineutrophil cytoplasmic antibodies and vasculitis.Curr Opin Rheumatol. 2010; 22: 43-48
- Trojan horses: drug culprits associated with antineutrophil cytoplasmic autoantibody (ANCA) vasculitis.Curr Opin Rheumatol. 2014; 26: 42-49
- Antineutrophil cytoplasmic antibody–positive small-vessel vasculitis associated with antithyroid drug therapy: how significant is the clinical problem?.Thyroid. 2015; 25: 1273-1281
- Hydralazine-associated vasculitis: overlapping features of drug-induced lupus and vasculitis.Semin Arthritis Rheum. 2018; 48: 283-287
- Rifampicin-induced antineutrophil cytoplasmic antibody-positive vasculitis: a case report and review of the literature.Int J Clin Pharmacol Ther. 2016; 54: 804-807
- Biological therapy-induced systemic vasculitis.Curr Rheumatol Rep. 2016; 18: 39
- Cocaine and ANCA associated vasculitis-like syndromes—a case series.Autoimmun Rev. 2018; 17: 73-77
- Proteinase-3 antineutrophil cytoplasm antibody positivity in patients without primary systemic vasculitis.J Clin Rheumatol. 2012; 18: 336-340
- Intravascular large B-cell lymphoma with a high titer of proteinase-3-anti-neutrophil cytoplasmic antibody mimicking granulomatosis with polyangiitis.Mod Rheumatol. 2019; 29: 195-197
- The usefulness of histopathological examinations of non-renal biopsies in the diagnosis of granulomatosis with polyangiitis.Reumatologia. 2017; 55: 230-236
- Efficacy of transbronchial biopsy in pulmonary vaculitides.Eur Respir J. 1997; 10: 2738-2743
- Histopathologic classification of ANCA-associated glomerulonephritis.J Am Soc Nephrol. 2010; 21: 1628-1636
- Investigations in systemic vasculitis—the role of renal pathology.Best Pract Res Clin Rheumatol. 2018; 32: 83-93
- The kidneys and ANCA-associated vasculitis: from pathogenesis to diagnosis.Clin Kidney J. 2015; 8: 343-350
- Polar views in Nephrology Pro: should all patients with anti-neutrophil cytoplasmic antibody-associated vasculitis be primarily treated with rituximab?.Nephrol Dial Transplant. 2015; 30: 1083-1087
- Long-term outcomes among participants in the WEGENT trial of remission-maintenance therapy for granulomatosis with polyangiitis (Wegener's) or microscopic polyangiitis.Arthritis Rheumatol. 2016; 68: 690-701
- Efficacy of remission-induction regimens for ANCA-associated vasculitis.N Engl J Med. 2013; 369: 417-427
- The characterisation and determinants of quality of life in ANCA associated vasculitis.Ann Rheum Dis. 2014; 73: 207-211
- Damage in the ANCA-associated vasculitides: long-term data from the European vasculitis study group (EUVAS) therapeutic trials.Ann Rheum Dis. 2015; 74: 177-184
- The use and misuse of antibiotics in dentistry: a scoping review.J Am Dent Assoc. 2018; 149 (e5): 869-884
Article info
Publication history
Published online: December 04, 2022
Accepted:
November 20,
2022
Received in revised form:
November 17,
2022
Received:
May 27,
2022
Identification
Copyright
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