Unit of Basic Oral Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia.
Clinical Immunology Group, Rheumatology and Immunology Department Hospital Militar Central/School of Medicine, Universidad Militar Nueva Granada, Transversal 3ª #, 49-00, Bogotá, Colombia.
BMC Oral Health. 2019 Nov 8;19(1):240. doi: 10.1186/s12903-019-0939-6.
Rheumatoid arthritis (RA) and periodontal disease are inter-related conditions. However, factors predictive of periodontal disease progression in patients with early rheumatoid arthritis (eRA) are lacking. The aim of this study was to identify factors associated with the progression of clinical attachment loss (CAL) in interproximal dental sites of eRA patients.
Twenty-eight eRA patients were evaluated for the progression of CAL at 280 interproximal dental sites at 1 year of follow-up. Markers of RA activity (rheumatoid factor, erythrocyte sedimentation rate, and C-reactive protein), a marker of bone resorption (Dickkopf-related protein 1), Disease Activity Score 28 and Simple Disease Activity Index were included as potential systemic predictive factors. Plaque index, gingival index, pocket depth, clinical attachment level and Dickkopf-related protein 1 in crevicular fluid at baseline were included as potential local predictive factors. Data were analysed in a hierarchical structure using generalised linear mixed models for progression at each site (> 2 mm) during follow-up.
C-reactive protein level was the most important predictive systemic factor for the progression of CAL. The mean CAL and a high degree of gingival inflammation in interproximal sites at baseline were important predictive local factors (p < 0.0001). Patients who received combined treatment with disease-modifying antirheumatic drugs and corticosteroids exhibited less CAL (p < 0.0001). The predictive value of the generalised linear mixed model for progression was 85%.
Systemic factors, including RA disease activity and baseline periodontal condition, were associated with periodontal progression. Pharmacological treatment may affect periodontal progression in patients with early RA.
类风湿关节炎（RA）和牙周病是相互关联的疾病。然而，缺乏预测早期类风湿关节炎（eRA）患者牙周病进展的因素。本研究旨在确定与 eRA 患者牙周附着丧失（CAL）进展相关的因素。
在 1 年的随访中，对 28 例 eRA 患者的 280 个牙周近中牙位的 CAL 进展情况进行评估。RA 活动的标志物（类风湿因子、红细胞沉降率和 C 反应蛋白）、骨吸收标志物（Dickkopf 相关蛋白 1）、疾病活动评分 28 和简单疾病活动指数被纳入潜在的系统性预测因素。基线时的菌斑指数、牙龈指数、牙周袋深度、临床附着水平和龈沟液中的 Dickkopf 相关蛋白 1 被纳入潜在的局部预测因素。使用广义线性混合模型对每个部位（随访期间>2mm）的进展进行分层结构分析。
C 反应蛋白水平是 CAL 进展最重要的预测性系统性因素。基线时近中部位 CAL 和高度牙龈炎症是重要的预测性局部因素（p<0.0001）。接受联合治疗的患者（包括疾病修饰抗风湿药物和皮质类固醇）CAL 减少（p<0.0001）。广义线性混合模型对进展的预测价值为 85%。
系统性因素，包括 RA 疾病活动和基线牙周状况，与牙周病的进展有关。药物治疗可能会影响早期 RA 患者的牙周病进展。
