Calderaro Débora Cerqueira, Corrêa Jôice Dias, Ferreira Gilda Aparecida, Barbosa Izabela Guimarães, Martins Carolina Castro, Silva Tarcília Aparecida, Teixeira Antônio Lúcio
Universidade Federal de Minas Gerais, Hospital das Clínicas, Serviço de Reumatologia, Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Biologia Celular, Belo Horizonte, MG, Brazil.
Rev Bras Reumatol Engl Ed. 2017 May-Jun;57(3):238-244. doi: 10.1016/j.rbre.2016.11.011. Epub 2017 Jan 4.
To evaluate the influence of periodontal treatment on rheumatoid arthritis activity.
MEDLINE/PUBMED, The Cochrane Library, Clinical Trials, SciELO and LILACS were searched for studies published until December 2014. Included articles were: prospective studies; including patients older than 18 years, diagnosed with periodontitis and rheumatoid arthritis submitted to non-surgical periodontal treatment; with a control group receiving no periodontal treatment; with outcomes including at least one marker of rheumatoid arthritis activity. Methodological quality of the studies was assessed using PEDro scale. Quantitative data were pooled in statistical meta-analysis using Review Manager 5.
Four articles were included. Non-surgical periodontal treatment was associated with a significant reduction of DAS28 (OR: -1.18; 95% CI: -1.43, -0.93; p<0.00001). Erythrocyte sedimentation rate, C-reactive protein, patient's assessment of rheumatoid activity using visual analogical scale, tender and swollen joint counts showed a trend toward reduction (not statistically significant).
The reduction of DAS 28 in patients with rheumatoid arthritis after periodontal treatment suggests that the improvement of periodontal condition is beneficial to these patients. Further randomized controlled clinical trials are necessary to confirm this finding.
评估牙周治疗对类风湿关节炎活动度的影响。
检索MEDLINE/PUBMED、考克兰图书馆、临床试验、科学电子图书馆在线（SciELO）和拉丁美洲及加勒比地区卫生科学数据库（LILACS），查找截至2014年12月发表的研究。纳入的文章为：前瞻性研究；纳入年龄大于18岁、诊断为牙周炎和类风湿关节炎且接受非手术牙周治疗的患者；设有未接受牙周治疗的对照组；结局包括至少一项类风湿关节炎活动度指标。使用PEDro量表评估研究的方法学质量。采用RevMan 5软件对定量数据进行统计荟萃分析。
纳入4篇文章。非手术牙周治疗与DAS28显著降低相关（OR：-1.18；95%CI：-1.43，-0.93；p<0.00001）。红细胞沉降率、C反应蛋白、患者使用视觉模拟量表对类风湿活动度的评估、压痛和肿胀关节计数呈降低趋势（无统计学意义）。
类风湿关节炎患者牙周治疗后DAS 28降低，提示牙周状况改善对这些患者有益。需要进一步的随机对照临床试验来证实这一发现。
