Patient-reported risk factors for recurrent aphthous stomatitis (RAS)

Objectives:

Recurrent aphthous stomatitis (RAS) is a painful ulcerative disease of the oral mucosa affecting 40% of the US population for more than 20 years in a lifetime. The etiology of RAS remains unclear. In an attempt to identify risk factors for RAS, we investigated changes in a number of patient-reported variables in the 48 hours immediately prior to the onset of RAS episodes.

Methods:

Data were collected during a case-control study at the University of Florida from June 2009 to April 2011 through standardized questionnaires and oral examinations. Controls never had RAS and cases (>2 idiopathic RAS ≤6 months ago) were ‘active’ (with clinical aphthae), or ‘inactive’ (no aphthae in ≤5 days). Main eligibility criteria were: age >12 years, fasting for >5 hours, no tobacco, alcohol or medications affecting the immune system within 24 hours prior to the visits. Participants reported changes in their mouth, appetite, stress, sleep, health, body pain, diet, exercise, ability to concentrate and phone use (used as negative control variable) in the 48 hours prior to a visit (or before RAS onset, if active cases), compared to the previous week.  Data stored in REDCap were analyzed using Fisher’s exact test or Cochran-Mantel-Haenszel test with modified ridit scores in SAS v9.2.

Results:

Data were available for 108 participants (48 controls, 30 active, and 30 inactive). Participants were 18-50 years old (23±5; mean±SD), 51% females, 64% White, and 19% Hispanic. More active cases (40%) reported increased mental stress levels vs. inactive cases (17%; p=0.048) or controls (15%; p=0.025). There were no significant changes for other variables.

Conclusions:

These results support an association between increased mental stress and the onset of RAS episodes and suggest that the other patient-reported variables we examined are not significant contributors or co-factors in the pathogenesis of RAS.