Romero-Sanchez Consuelo, Rodríguez C, Santos-Moreno P, Mesa A M, Lafaurie G I, Giraldo-Q S, De-Avila J, Castillo D M, Duran M, Chalem P Ch, Bello Gualtero J M, Valle-Oñate R
Universidad El Bosque. Av. Cra 9 No. 131 A - 02, Bogotá, 111121, Colombia.
Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia.
Curr Rheumatol Rev. 2017;13(2):139-151. doi: 10.2174/1573397113666170407161520.
Experimental models suggest the use of different therapy protocols in rheumatoid arthritis (RA) as modulators on periodontal condition. This study evaluated the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity.
One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-. and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR).
Anti-TNF-alpha therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-alpha therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The type of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030).
Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota.
实验模型表明，在类风湿关节炎（RA）中使用不同的治疗方案可作为牙周状况的调节因子。本研究评估了RA患者接受传统药物治疗和抗TNF治疗对微生物学和牙周状况的影响，确定了牙周感染标志物与风湿活动指标之间的关联。
对179例RA患者进行了评估（62例接受抗TNF-α治疗，115例仅接受改善病情抗风湿药治疗）。牙周评估包括菌斑和牙龈指数、探诊出血（BOP）、临床附着丧失（CAL）、牙周袋深度（PD）以及用于微生物分析的龈下菌斑样本。风湿学评估包括临床检查、类风湿因子（RF）、抗环瓜氨酸肽抗体（ACPA）以及活动标志物（DAS28-ERS）、高敏C反应蛋白（hs-CRP）、红细胞沉降率（ESR）。
抗TNF-α治疗影响牙周微生物群，具核梭杆菌的检出频率更高（p=0.01）。甲氨蝶呤联合来氟米特导致CAL扩展程度更高（p=0.005），而抗TNF-α治疗联合甲氨蝶呤与较低的CAL扩展程度相关（p=0.05）。使用皮质类固醇对牙齿数量有保护作用（p=0.027）。改善病情抗风湿药的类型影响牙龈卟啉单胞菌、福赛坦氏菌和具核梭杆菌的存在情况。ACPA滴度升高与红色复合体牙周病原体的存在相关（p=0.025）。探诊出血与CPR水平升高相关（p=0.05），ESR与更大的PD（p=0.044）以及红色复合体的存在相关（p=0.030）。
RA的不同药物治疗会影响临床状况和龈下微生物群。
