{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T18:20:30Z","timestamp":1782498030100,"version":"3.54.5"},"update-to":[{"DOI":"10.12688\/f1000research.55332.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000}},{"DOI":"10.12688\/f1000research.55332.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000}},{"DOI":"10.12688\/f1000research.55332.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000}}],"reference-count":32,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This article has no funding source"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"\n Background:<\/ns3:bold>\n Several systemic diseases manifest themselves in the oral cavity. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population.\n <\/ns3:p>\n \n Methods:<\/ns3:bold>\n The present cross-sectional study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr El Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Patients\u2019 medical records were evaluated. \u00a0\n <\/ns3:p>\n The oral manifestations were assessed according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization.<\/ns3:p>\n \n Results:<\/ns3:bold>\n Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in SLE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic.\u00a0\n <\/ns3:p>\n \n Conclusions:<\/ns3:bold>\n The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with SLE as the WHO considers oral manifestations of SLE a widespread state. Also, the implementation of oral hygiene measures to improve patients\u2019 nutritional state and health-related quality of life is recommended.\n <\/ns3:p>","DOI":"10.12688\/f1000research.55332.4","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T09:15:05Z","timestamp":1654506905000},"page":"969","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5000-215X","authenticated-orcid":false,"given":"Hager Moustafa","family":"Saeed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Mohammad Amr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alshaimaa","family":"Rezk Lotfy Rezk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesam","family":"Abd Elmoneim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"558-564","DOI":"10.1111\/j.1600-0560.2006.00652.x","article-title":"Lupus erythematosus: Clinical and histopathological study of oral manifestations and immunohistochemical profile of the inflammatory infiltrate.","volume":"34","author":"S Louren\u00e7o","year":"2007","journal-title":"Journal of Cutaneous Pathology."},{"key":"ref2","first-page":"38-42","article-title":"Oral mucosal lesions in systemic lupus erythematosus--a clinical, histopathological and immunopathological study.","volume":"11","author":"R Jonsson","year":"1984","journal-title":"J Rheumatol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"389-394","DOI":"10.1016\/0190-9622(92)70204-S","article-title":"Oral lesions in systemic lupus erythematosus. 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Alonso-perez","year":"2011"}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-969\/v4\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-969\/v4\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-969\/v4\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T12:40:38Z","timestamp":1655124038000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-969\/v4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,6]]},"references-count":32,"URL":"https:\/\/doi.org\/10.12688\/f1000research.55332.4","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.134585.r139745","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.134585.r139745","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,6]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-969\/v4#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.122370.r127698, Syahrul Sazliyana Shaharir, Department of Internal Medicine, Rheumatology Unit, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, 22 Mar 2022, version 3, 1 approved, 1 approved with reservations, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/10-969\/v3#referee-response-127698","order":0,"name":"referee-response-127698","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.58897.r101743, Laura B. Lewandowski, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA, 05 Jan 2022, version 1, 2 not approved","URL":"https:\/\/f1000research.com\/articles\/10-969\/v1#referee-response-101743","order":1,"name":"referee-response-101743","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Hager Saeed<\/b>; \nPosted: 06 Jan 2022<\/i>; \nDear Laura,<\/b> Thanks for your valuable report, I appreciate all your efforts to write this constructive report.  I do my efforts to be concise in the paper as this paper is the summary of the thesis defense which is about 150 pages. Unfortunately, I couldn\u2019t share the full thesis with you to learn more from your wide experience.  \nThe clinical description of oral lesions, both type and location references <\/b>           Burket\u2019s Oral Medicine, 12th Edition - Michael Glick - Google Books. Accessed August 23, 2021. https:\/\/books.google.com.eg\/books?hl=en&lr=&id=cBEqCAAAQBAJ&oi=fnd&pg=PR1&dq=burket%E2%80%99s+oral+medicine.&ots=hkfOb1399V&sig=GjVjm9Gg5OGxOsyAph5UwMfx_XQ&redir_esc=y#v=onepage&q=burket%E2%80%99s%20oral%20medicine.&f=false This reference was used in  \u2022    Khatibi M, Shakoorpour AH, Jahromi ZM, Ahmadzadeh A. The prevalence of oral mucosal lesions and related factors in 188 patients with systemic lupus erythematosus. Lupus. 2012 Oct;21(12):1312\u20135. \u2022    Hammoudeh M, Al-momani A, Sarakbi H, Chandra P, Hammoudeh S. Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study. International Journal of Rheumatology. 2018;2018:1-7. doi:10.1155\/2018\/6052326 \u2022    Hadidi KT El, Medhat BM, Baki NMA, Kafy HA, Abdelrahaman W, Yousri AY. Characteristics of systemic lupus erythematosus in a sample of the Egyptian population\u202f: a retrospective cohort of 1109 patients from a single center. 2018;(December 2017):1\u20139. \nIntroduction: \u2022    "The prevalence of mucosal involvement in LE patients is debatable." - There are multiple reports on mucosal involvement in SLE. Authors should state there is a range based on population and cite the following: 1, 2, 3<\/b> Thank you for this valuable addition.   \u2022    "\nThe WHO considers the oral manifestations of LE as a widespread state associated with a significantly increased risk of cancer.\u201d <\/b>\u2013  Thank you for this valuable addition. I removed this part. \u2022   \n Inclusion criteria: Patients recently diagnosed with lupus erythematosus based on American College of Rheumatology (ACR) criteria. How did the authors define a recent diagnosis?<\/b> The Internal Medicine Department, Rheumatology Clinics in EL Qasr EL Ainy Hospital, Cairo University, has two clinics for lupus patients. Clinic One is only for new patient diagnosis, and Clinic Two is for treatment follow-up. New patients arrive at Clinic 1 in search of a diagnosis and are given Medical Record numbers. Clinic 1 was where all of the new patients were diagnosed. Patients with MRN who needed to be followed up on went to clinic 2. The research was carried out at Clinic No. 1. Only patients who were diagnosed immediately according to ACR criteria were included in the study. All of the patients in Clinic One had not previously received any lupus medication.   \u2022   \n Exclusion criteria - Patients who had received any previous therapy for lupus erythematosus. Authors should state treatment of naïve patients in the inclusion criteria.<\/b> Yes, the study was conducted in clinic number one, which is for new patients only. Only patients who were immediately diagnosed were included, as stated in the inclusion criteria. All of the patients in Clinic One were immediately diagnosed and had not previously received any lupus medication. In the thesis, we defined the drugs for lupus treatment as: Systemic Corticosteroids High doses (40 to60 mg\/d of prednisone or prednisone equivalent) are used in patients with severe SLE. Doses of 10 mg\/d or less are used for milder SLE for treatment of cutaneous and musculoskeletal symptoms not responding to other therapies. (Mehat et al., 2017) Immunosuppressants - Patients who are not responsive to anti-malarials or glucocorticoids should be considered for treatment with immunosuppressive agents for more severe manifestations of the disease (Bernknopf, 2015): \u2022    Methotrexate. (MTX) is a folic acid analog which inhibits the enzyme dihydrofolate reductase and, as consequences of the proliferation of T cell populations (Bernknopf, 2015).   \u2022    Mycophenolate mofetil and mycophenolate sodium. Decreased activity of this enzyme affects proliferation of B and T lymphocytes induces apoptosis of activated T lymphocytes (Winkelmann, 2013).   \u2022    Azathioprine. is the prodrug of 6- mercaptopurine, Side effects include bone-marrow toxicity, gastrointestinal symptoms and hepatotoxicity (Winkelmann, 2013).   \u2022    Clofazimine. is an antibiotic with immunosuppressive and anti-inflammatory activity traditionally used in the treatment of leprosy (Winkelmann, 2013). BIOLOGIC AGENTS \u2022    Intravenous immunoglobulin (IVIG). IVIG is the product of pooling immunoglobulin G (IgG) immunoglobulins extracted from donor blood (Winkelmann, 2013).   \u2022    Rituximab. Rituximab is a chimeric anti-CD20 monoclonal antibody that induces depletion of B cells through both antibody-dependent and independent pathways (Winkelmann, 2013). IMMUNOMODULATORS \u2022    Dapsone - Dapsone is a sulfone that inhibits dihydrofolic acid synthesis and exhibits both antibiotic and anti-inflammatory properties.   \u2022    Thalidomide - The effects of thalidomide are attributed to the inhibition of TNF-alpha synthesis and UVB-induced keratinocyte apoptosis.   \u2022    Lenalidomide - Lenalidomide is a structural analog of thalidomide with more potent immune-modulatory effects and a lower risk of polyneuropathy (Winkelmann, 2013).   \u2022   \n "The diagnosis of oral candidiasis was made by curd-like patches on the tongue or other oral mucosal surfaces, the presence of classic pseudomembranous lesions characterized by a creamy white pseudomembrane" - was this confirmed by any culture or biopsy?<\/b> \nAccording to Hopkins Lupus Cohort. <\/u> The diagnosis of oral candidiasis was made by the presence of classic pseudomembranous lesions characterized by creamy white, curd-like patches on the tongue or on other oral mucosal surfaces. Oral candidiasis was defined at every visit by visual inspection of the oral cavity by one rheumatologist (Dr. Michelle Petri). Fangtham M, Magder LS, Petri MA. Oral candidiasis in systemic lupus erythematosus. Lupus. 2014; \nResults: \u2022    Table 1 should include an overall demographic data for all participants- age, sex, smoking, presence of oral lesions.<\/b>  Thank you for this constructive addition. \u2022   \n Table 1 should be Table 2.<\/b> Thank you for this constructive addition. I should back to the editor in this point. \u2022  \n  Figure 1 - would change to anatomical sites of oral lesions. How did the authors standardize the bounds of each lesion?<\/b>  according to the methodology, we follow the mentioned references in the clinical description and clinical site.        Burket\u2019s Oral Medicine, 12th Edition - Michael Glick - Google Books. Accessed August 23, 2021. https:\/\/books.google.com.eg\/books?hl=en&lr=&id=cBEqCAAAQBAJ&oi=fnd&pg=PR1&dq=burket%E2%80%99s+oral+medicine.&ots=hkfOb1399V&sig=GjVjm9Gg5OGxOsyAph5UwMfx_XQ&redir_esc=y#v=onepage&q=burket%E2%80%99s%20oral%20medicine.&f=false \u2022   \n Figure 3: I am a bit confused about the inclusion of the data on the skin manifestations. Unless the authors have a specific hypothesis they would like to explore with this data, it seems out of place in this paper on oral lesions in SLE.<\/b> Thank you for this constructive addition. According to your direction, We removed this part.   \n\u2022    "The sampled population was classified into two groups. LE patients who had an oral manifestation as true positive oral lesions (TP) and LE patients without oral manifestation as true negative oral lesions (TN)." - I think this language is confusing, as they do not discover false positives or negatives in this study. I would change this to present or absent.<\/b> Thank you for this constructive addition. According to your direction, We amend it. \nDiscussion: \u2022    "CLE patients weren\u2019t found in the sampled population" - they were excluded based on methods stated above.<\/b>  Thanks for your notification, but we didn\u2019t exclude CLE. All the sampled patients had systemic involvement. \n\u2022    "Interestingly, one of our patients reported symptoms of numbness and facial sensory impairment, which indicates the involvement of sensory ganglia of the cranial nerves. Loss of taste and dry mouth were reported as the first manifestation of SLE in this patient. The serological result reported that the antinuclear antibody was present in a titer of 1\/320, and the CT scan examination of the brain revealed that the patient had had a stroke. This may be attributed to the autoimmune autoantibodies directed against sensory ganglion":<\/b> Thank you for this constructive addition, I removed the case. But, to clarify your doubts the patients was positive anti-phospholipid antibodies   \u2022    \n"In the current study, oral candidiasis was observed in 41% of all the patients. Moreover, (74.3%) patients had oral lesions superinfected by Candida." - this was based on appearance and not culture\/biopsy? I think this needs to be removed as this is not confirmed Candida according to the methods.<\/b> Thank you for this constructive addition, I removed this part. \nConclusion: \u2022    The link to cancer is not substantiated by current evidence and needs to be removed. I agree that more research in diverse settings is critical. Do the authors have a citation for the claim that research is only conducted in 1 in 10 countries? All research? Research on SLE? If no citation please make a more broad statement.<\/b> Thank you for this constructive addition, I amended this part. But to clarify your doubts,  this was mentioned by another reviewer as only 1\/10 of all countries in the world assessed the prevalence of oral manifestation in lupus erythematosus. ","URL":"https:\/\/f1000research.com\/articles\/10-969\/v4#referee-comment-7669","order":2,"name":"referee-comment-7669","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Hager Saeed<\/b>; \nPosted: 28 Mar 2022<\/i>; I hope you're doing well. In accordance with your report, we have submitted the third version.  If you have any further questions, please let us know so we will make the necessary changes.  Thank you for the detailed instructions.","URL":"https:\/\/f1000research.com\/articles\/10-969\/v4#referee-comment-8015","order":3,"name":"referee-comment-8015","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.134585.r139745, Ljudmila Stojanovich, University Medical Center of Belgrade University, Belgrade, Serbia, 08 Jun 2022, version 4, indexed","URL":"https:\/\/f1000research.com\/articles\/10-969\/v4#referee-response-139745","order":4,"name":"referee-response-139745","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Hager Saeed<\/b>; \nPosted: 10 Jun 2022<\/i>; Thanks for your response. Please accept our sincere gratitude for your insightful input.","URL":"https:\/\/f1000research.com\/articles\/10-969\/v4#referee-comment-8354","order":5,"name":"referee-comment-8354","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":6,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}