J Clin Periodontol 2005; 32: 412–416 doi: 10.1111/j.1600-051X.2005.00689.x Periodontal infection as a possible severity factor for rheumatoid arthritis Copyright r...
Extrait du document
«
J Clin Periodontol 2005; 32: 412–416 doi: 10.1111/j.1600-051X.2005.00689.x
Periodontal infection as a
possible severity factor for
rheumatoid arthritis
Copyright r Blackwell Munksgaard 2005
Juliana Ribeiro1, Anna Leão1 and
Arthur B.
Novaes2
1
Department of Periodontology, School of
Dentistry, Federal University of Rio de
Janeiro, RJ; 2Department of Bucco-MaxilloFacial Surgery and Traumatology and
Periodontology, School of Dentistry of
Ribeirão Preto, University of São Paulo,
Ribeirão Preto, SP, Brazil
Ribeiro J, Leão A, Novaes AB.
Periodontal infection as a possible severity factor for
rheumatoid arthritis.
J Clin Periodontol 2005; 32: 412–416.
doi: 10.1111/j.1600051X.2005.00689.x.
r Blackwell Munksgaard, 2005.
Abstract
Objective: Clinical effects of periodontal treatment on biochemical and clinical
markers of disease severity in rheumatoid arthritis (RA) patients with periodontal
disease were evaluated.
Methods: Forty-two patients were assigned to two groups, G1 (n 5 16) and G2
(n 5 26).
G1 patients were submitted to oral hygiene instruction and professional tooth
cleaning and G2 patients additionally had full-mouth scaling and root planing (SRP).
Clinical periodontal measurements were obtained at baseline and 3 months after
periodontal treatment.
A Health Assessment Questionnaire (HAQ) was used to
evaluate their performance on daily living.
Rheumatoid factor (RF), erythrocyte
sedimentation rate (ESR) and drug therapy were assessed.
Results: Both groups presented a full-mouth improvement in all periodontal clinical
parameters (po0.05), with the exception of clinical attachment level (CAL) and
probing pocket depth (PPD) 46 mm for G1.
G2 showed greater mean reductions on
PPD 44 mm than G1 (po0.001).
HAQ analyses showed a reduction on the degree of
disability of G2, but not statistically significant.
ESR was significantly reduced for G2
after SRP although RF did not show statistical reductions.
Conclusion: The data suggest that periodontal treatment with SRP might have an
effect on the ESR reduction.
Periodontal medicine is an emerging
branch of periodontology that has been
establishing a strong relationship between
periodontal and systemic health or disease (Offenbacher 1996, Williams &
Offenbacher 2000).
Periodontal disease (PD) and its
mechanism of inflammatory reactions
result in the destruction of tissue and
bone in a pattern similar to that which
mediate destruction of soft tissue and
erosion of bone in rheumatoid arthritis
(RA).
In both conditions a persistent
inflammatory reaction occurs in areas
composed of connective tissue and bone
with the activation of complement,
production of cytokines and release of
other inflammatory cell products (Snyderman & McCarty 1982).
The similarity between RA and PD has prompted
412
several studies of periodontal status in
patients with RA although the findings
reported on the relationship between RA
and PD are not concordant (Malmström
& Calonius 1975, Sjostrom et al.
1989,
Yavuzyilmaz et al.
1992, Tolo &
Jorkjend 1990, Mercado et al.
2000,
2001).
Differences in disease criteria
and methods for evaluation of the periodontal status form a major problem in
interpretation of the literature.
Most of
these studies observed the influence of
RA over PD but the literature on the
systemic impact of periodontal treatment on RA is still scant.
Coexistence of PD and RA would
offer an interesting opportunity to study
the possible influence of PD inflammatory process on RA progression.
The
hypothesis that the destructive inflam-
Key words: basic periodontal treatment;
periodontal disease/treatment; periodontal
medicine; rheumatoid arthritis; risk factors
Accepted for publication 23 August 2004
matory disorder of PD may influence
RA or vice-versa warrants consideration.
The aim of this preliminary study
was to evaluate the influence of periodontal treatment on the measuring parameters of the inflammatory reaction
caused by RA.
Materials and Methods
Subject population
The subject population consists of a
sample of 42 consecutive patients attending the University Hospital Rheumatology Clinic, with RA, diagnosed according to the parameters of the American
Rheumatology Association (Arneberg
et al.
1992).
After approval of the
University Hospital Human Research
Periodontitis influencing arthritis
Committee the patients were invited to
take part in this pilot study.
All subjects
were X40 years of age, had at least X2
teeth and at least X2 sites with pocket
depths X5 mm and attachment level
X6 mm at baseline (Machtei et al.
1992).
Exclusion criteria included xerostomia, pregnancy or lactancy and systemic conditions that could affect the
progression or treatment of PDs.
In addition, subjects that required antibiotics for
treatment during the last 6 months and
smokers were excluded.
Drugs used by
the subjects to treat RA were assessed
through their medical files.
RA clinical measurements
Patients disability status was measured
by the Stanford Health Assessment
Questionnaire (HAQ) Functional Disability Index (DI) (Wolfe et al.
1988).
A score of one on DI indicates that, on
the average, the patient has difficulty in
every area of daily living (moderate
disability), while a score of two indicates that he has high degree of difficulty or requires assistance in every area
of daily living (severe disability).
Biochemical measurements
Venous blood was....
»
↓↓↓ APERÇU DU DOCUMENT ↓↓↓