Dentistry Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Clin Rheumatol. 2012 Jun;18(4):180-4. doi: 10.1097/RHU.0b013e31825828be.
This study aimed to evaluate prospectively the influence and the evolution of periodontal disease (PD) in rheumatoid arthritis (RA) patients submitted to anti-tumor necrosis factor (TNF) therapy.
Eighteen patients with RA (according to the American College of Rheumatology criteria) were assessed for PD before (BL) and after 6 months (6M) of anti-TNF treatment: 15 infliximab, 2 adalimumab, and 1 etanercept. Periodontal assessment included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Rheumatologic evaluation was performed blinded to the dentist's assessment: demographic data, clinical manifestations, and disease activity (Disease Activity Score using 28 joints [DAS28], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]).
The median age and disease duration of patients with RA were 50 years (25-71 y) and 94% were female. Periodontal disease was diagnosed in 8 patients (44.4%). Comparing BL to 6M, periodontal parameters in the entire group remained stable (P > 0.05) throughout the study (plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level), whereas an improvement in most analyzed RA parameters was observed in the same period: DAS28 (5.5 vs. 3.9, P = 0.02), ESR (21 vs. 12.5 mm/first hour, P = 0.07), and CRP (7.8 vs. 2.8 mg/dL, P = 0.25). Further analysis revealed that this improvement was restricted to the group of patients without PD (DAS28 [5.5 vs. 3.6, P = 0.04], ESR [23.0 vs. 11.5 mm/first hour, P = 0.008], and CRP [7.4 vs. 2.1, P = 0.01]). In contrast, patients with PD had lack of response, with no significant differences in disease activity parameters between BL and 6M: DAS28 (5.2 vs. 4.4, P = 0.11), ESR (17.0 vs. 21.0, P = 0.56), and CRP (9.0 vs. 8.8, P = 0.55).
This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition.
本研究旨在前瞻性评估类风湿关节炎（RA）患者在接受抗肿瘤坏死因子（TNF）治疗后牙周病（PD）的影响和演变。
18 例 RA 患者（根据美国风湿病学会标准）在接受抗 TNF 治疗前（BL）和 6 个月后（6M）进行 PD 评估：15 例英夫利昔单抗、2 例阿达木单抗和 1 例依那西普。牙周评估包括菌斑和牙龈出血指数、探诊袋深度、釉牙骨质界和临床附着水平。在牙医评估的基础上，对风湿病学进行了盲法评估：人口统计学数据、临床表现和疾病活动度（使用 28 个关节的疾病活动评分[DAS28]、红细胞沉降率[ESR]和 C 反应蛋白[CRP]）。
RA 患者的中位年龄和疾病持续时间为 50 岁（25-71 岁），94%为女性。8 例（44.4%）患者诊断为 PD。与 BL 相比，整个研究期间（菌斑和牙龈出血指数、探诊袋深度、釉牙骨质界和临床附着水平），6M 时牙周参数保持稳定（P>0.05），而在此期间，大多数分析的 RA 参数均有所改善：DAS28（5.5 比 3.9，P=0.02）、ESR（21 比 12.5mm/首小时，P=0.07）和 CRP（7.8 比 2.8mg/dL，P=0.25）。进一步分析表明，这种改善仅限于无 PD 组患者（DAS28[5.5 比 3.6，P=0.04]、ESR[23.0 比 11.5mm/首小时，P=0.008]和 CRP[7.4 比 2.1，P=0.01]）。相比之下，PD 患者反应不佳，BL 和 6M 之间疾病活动参数无显著差异：DAS28（5.2 比 4.4，P=0.11）、ESR（17.0 比 21.0，P=0.56）和 CRP（9.0 比 8.8，P=0.55）。
本研究支持 PD 可能影响 RA 患者 TNF 阻滞剂疗效的观点。持续的牙龈炎症状态可能会阻碍这种疾病的治疗反应，这具有很高的临床意义，因为这是一种可治疗的疾病。
