Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany.
Dental Practice Dr. Frank Paschereit, Northeim, Germany.
J Periodontol. 2018 Nov;89(11):1310-1317. doi: 10.1002/JPER.17-0616. Epub 2018 Aug 23.
The aim of this cross-sectional study was to investigate clinical periodontal findings as well as prevalence of selected potentially periodontal pathogenic bacteria in patients with rheumatoid arthritis (RA) treated with different immunosuppressive rheumatic medications.
One hundred sixty-eight patients with RA undergoing different immunosuppressive medications were included and divided into subgroups according to their medication, which was taken in the past 6 months, in detail, 1) non-steroidal anti-inflammatory drugs (NSAID) and glucocorticoids combined, and the following different disease modifying anti-rheumatic drugs (DMARDs): 2) methotrexate (MTX), 3) leflunomide, 4) MTX and TNF-α antagonists combined, 5) interleukin-6 (IL-6) antagonist, 6) MTX and rituximab combined, and 7) combination therapies of > 2 of these DMARDs. Periodontal examination consisted of papilla bleeding index (PBI), periodontal status with periodontal probing depth (PD), bleeding on probing (BOP), and clinical attachment loss (AL). Periodontitis was classified as none/mild, moderate, or severe. Samples obtained from gingival crevicular fluid were analyzed for presence of 11 periodontal pathogenic bacteria.
Patients with MTX + TNF-α antagonists therapy showed higher PBI and BOP values compared with leflunomide (P < 0.01) and higher BOP than MTX + rituximab (P = 0.02). Porphyromonas gingivalis (P < 0.01), Treponema denticola (P < 0.01), Fusobacterium nodatum (P = 0.02) and Capnocytophaga species (P = 0.05) was associated with medication subgroup, whereby post hoc testing confirmed singular differences for several medication subgroups.
RA medication is associated with periodontal inflammation, without differences in periodontal disease severity. Thereby, combination of MTX + TNF-α shows an increased potential to periodontal inflammation. Additionally, several differences in prevalence of selected bacteria were detected.
本横断面研究旨在调查接受不同免疫抑制风湿药物治疗的类风湿关节炎（RA）患者的临床牙周表现以及选定的潜在牙周致病菌的流行情况。
纳入 168 例正在接受不同免疫抑制药物治疗的 RA 患者，并根据其在过去 6 个月内服用的药物（详细为 1）非甾体抗炎药（NSAID）和糖皮质激素联合，以及以下不同的疾病修正抗风湿药物（DMARD）进行分组：2）甲氨蝶呤（MTX），3）来氟米特，4）MTX 和 TNF-α 拮抗剂联合，5）白细胞介素-6（IL-6）拮抗剂，6）MTX 和利妥昔单抗联合，以及 7）> 2 种这些 DMARD 的联合治疗。牙周检查包括探诊出血指数（PBI）、牙周探诊深度（PD）、探诊出血（BOP）和临床附着丧失（AL）。牙周炎分为无/轻度、中度或重度。从牙龈沟液中获得的样本用于分析 11 种牙周致病菌的存在情况。
与来氟米特（P < 0.01）相比，接受 MTX + TNF-α 拮抗剂治疗的患者的 PBI 和 BOP 值更高，与 MTX + 利妥昔单抗（P = 0.02）相比，BOP 值更高。牙龈卟啉单胞菌（P < 0.01）、齿密螺旋体（P < 0.01）、梭杆菌属（P = 0.02）和嗜二氧化碳噬纤维菌属（P = 0.05）与药物亚组相关，事后检验证实了几个药物亚组的差异。
RA 药物与牙周炎症有关，而牙周疾病严重程度无差异。因此，MTX + TNF-α 的联合使用显示出增加牙周炎症的潜力。此外，还检测到选定细菌的流行情况存在一些差异。
