J Clin Periodontol 2005; 32: 412-416 doi: 10.

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 Leao1 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 ~ ~ Ribeirao Preto, University of Sao Paulo, ~ Ribeirao Preto, SP, Brazil ~o Ribeiro J, Lea 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 (Malmstrom & 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 obtained and the erythrocyte sedimentation rate (ESR) was quantified using the Westergreen method (Sox & Liang 1986). Corresponding results were registered and accessed from the patient's medical files. The RA activity was determined with ESR X28 mm3 (Wolfe & Michaud 1994). ESR was further characterized by determining, for each patient, the first ESR at baseline and the last ESR value, 3 months after periodontal therapy. The latex method was used to measure rheumatoid factor IgM (IgM-RF) (Singer 1961, Johnson & Faulk 1976, Baum & Ziff 1985). Results were obtained from patients...