良好口腔卫生对类风湿关节炎临床转归的作用：嵌套在 ESPOIR 队列中的一项随机研究。

Role of good oral hygiene on clinical evolution of rheumatoid arthritis: a randomized study nested in the ESPOIR cohort.

机构信息

Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, INSERM UMR1184, Le Kremlin Bicêtre.

Department of Epidemiology, Université Paris-Descartes, Paris.

出版信息

Rheumatology (Oxford). 2020 May 1;59(5):988-996. doi: 10.1093/rheumatology/kez368.

DOI:10.1093/rheumatology/kez368

PMID:31504982

Abstract

OBJECTIVE

There is a relationship between RA and periodontal disease. We aimed to investigate if a good oral hygiene could improve activity of RA.

METHODS

The patients with RA according to ACR/EULAR 2010 criteria and included in the French early arthritis ESPOIR cohort were included in a randomized nested study into: (i) intervention group: general recommendations of good oral hygiene including teeth brushing, daily antiseptic mouthwash and twice a year scaling; and (ii) control group: no intervention. The primary end point was the delta DAS28-ESR.

RESULTS

Four hundred and seventy-two patients were randomized (238 in intervention and 234 in control). 92/238 from the intervention group accepted the procedure and 81 had a first visit to the dentist. 56% of patients had periodontal disease at baseline. Duration of RA was 9.0±0.7 years. Baseline DAS28-ESR was 2.7±1.3. After a median duration of 24 months, delta DAS28-ESR was -0.17±1.29 and -0.09±1.28 in intervention and control groups, respectively (mean difference (complier average causal effect): -0.37 (95% CI -1.12, 0.37), P = 0.33). In the intervention group, there was a significant decrease of the bacteria involved in the red complex: Porphyromonas gingivalis (P = 0.002), Tannerella forsythia (P = 0.002) and Treponema denticola (P = 0.019). The patients with baseline periodontal disease and those who became negative for one red complex bacterium had a slightly more important decrease of DAS28-ESR.

CONCLUSION

Oral hygiene instruction together with regular scaling and polishing of the teeth significantly decreased the load of periodontal pathogens but did not decrease RA activity. This intervention should be tested in patients with earlier RA and more active disease.

TRIAL REGISTRATION

ClinicalTrials.gov, http://clinicaltrials.gov, NCT01831648.

摘要

目的

类风湿关节炎（RA）与牙周病之间存在关联。本研究旨在探究良好的口腔卫生是否能改善 RA 的活动度。

方法

根据 ACR/EULAR 2010 标准确诊为 RA 且纳入法国早期关节炎 ESPOIR 队列的患者被纳入一项随机嵌套研究，分为：（i）干预组：接受包括刷牙、每日使用抗菌漱口水和每年两次洁牙在内的一般口腔卫生建议；（ii）对照组：不进行干预。主要终点为 DAS28-ESR 的差值。

结果

共 472 例患者被随机分组（干预组 238 例，对照组 234 例）。238 例患者中，92 例接受了该程序，81 例首次就诊于牙医。基线时，56%的患者患有牙周病。RA 的病程为 9.0±0.7 年。基线时 DAS28-ESR 为 2.7±1.3。中位随访 24 个月后，干预组和对照组的 DAS28-ESR 差值分别为-0.17±1.29 和-0.09±1.28（平均差异（遵从平均因果效应）：-0.37（95%CI-1.12,0.37），P=0.33）。在干预组中，与红色复合体相关的细菌数量显著减少：牙龈卟啉单胞菌（P=0.002）、福赛斯坦纳菌（P=0.002）和牙髓密螺旋体（P=0.019）。基线时患有牙周病和一种红色复合体细菌转为阴性的患者，DAS28-ESR 的下降幅度略大。