Silvestre F-J, Silvestre-Rangil J, Bagán L, Bagán J-V
Pacientes Especiales, Clínica Odontológica Universitaria, C/ Gascó Oliag 1, 46010-Valencia Spain,
Med Oral Patol Oral Cir Bucal. 2016 May 1;21(3):e349-54. doi: 10.4317/medoral.20974.
Periodontitis has been regarded as a potential risk factor for rheumatoid arthrosis (RA). A systematic review is made to determine whether nonsurgical periodontal treatment in patients with RA offers benefits in terms of the clinical activity and inflammatory markers of the disease.
A search was made of the Medline-PubMed, Cochrane, Embase and Scopus databases to identify studies on the relationship between the two disease processes, and especially on the effects of nonsurgical treatment in patients of this kind. The search was based on the following keywords: rheumatoid arthritis AND periodontitis (MeSH), rheumatoid arthritis AND periodontal treatment.
Eight articles on the nonsurgical treatment of patients with periodontitis and RA were finally included in the study. All of them evaluated clinical (DAS28) and laboratory test activity (ESR, CRP, IL-6, TNFα) before and after treatment. A clear decrease in DAS28 score and ESR was recorded, while other parameters such as CRP, IL-6 and TNFα showed a nonsignificant tendency to decrease as a result of treatment.
Nonsurgical treatment improved the periodontal condition of patients with periodontitis and RA, with beneficial effects upon the clinical and laboratory test parameters (DAS28 and ESR), while other inflammatory markers showed a marked tendency to decrease. However, all the studies included in the review involved small samples sizes and follow-up periods of no more than 6 months. Larger and particularly longitudinal studies are therefore needed to more firmly establish possible significant relations between the two disease processes.
牙周炎被认为是类风湿性关节炎（RA）的潜在危险因素。进行一项系统评价，以确定类风湿性关节炎患者的非手术牙周治疗是否对该疾病的临床活动和炎症标志物有益。
检索Medline-PubMed、Cochrane、Embase和Scopus数据库，以确定关于这两种疾病过程之间关系的研究，特别是关于此类患者非手术治疗效果的研究。检索基于以下关键词：类风湿性关节炎与牙周炎（医学主题词）、类风湿性关节炎与牙周治疗。
该研究最终纳入了8篇关于牙周炎和类风湿性关节炎患者非手术治疗的文章。所有文章均评估了治疗前后的临床（疾病活动评分28，DAS28）和实验室检查活动（红细胞沉降率，ESR；C反应蛋白，CRP；白细胞介素-6，IL-6；肿瘤坏死因子α，TNFα）。记录到DAS28评分和ESR明显下降，而其他参数如CRP、IL-6和TNFα治疗后虽有下降趋势但无统计学意义。
非手术治疗改善了牙周炎和类风湿性关节炎患者的牙周状况，对临床和实验室检查参数（DAS28和ESR）产生了有益影响，而其他炎症标志物也有明显下降趋势。然而，该综述纳入的所有研究样本量较小，随访期不超过6个月。因此，需要更大规模特别是纵向研究，以更确切地确定这两种疾病过程之间可能存在的显著关系。
