Discipline of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry at Bauru, University of São Paulo, Bauru, Brazil.
Lauro de Souza Lima Institute, São Paulo State Health Secretariat, Bauru, Brazil.
Front Immunol. 2021 Mar 25;12:591236. doi: 10.3389/fimmu.2021.591236. eCollection 2021.
Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge - host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE-) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE-( < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE-, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.
系统性红斑狼疮(SLE)是一种复杂的慢性自身免疫性疾病,其特征是组织损伤和广泛炎症,以应对环境挑战。免疫复合物在肾脏肾小球中的沉积与狼疮肾炎有关,这决定了 SLE 的诊断。牙周炎是一种慢性炎症性疾病,其特征是临床附着丧失和骨丧失,由微生物挑战-宿主反应相互作用引起。免疫复合物在牙龈组织中的沉积是该疾病过程中的常见发现。考虑到这一点,本研究的主要目的是比较系统性红斑狼疮患者与系统性健康对照者牙龈组织中免疫复合物的沉积,并将其与牙周和系统参数相关联。本研究纳入了 25 名被诊断为系统性红斑狼疮(SLE+)的女性和 25 名年龄匹配的系统性健康对照者(SLE-)。从病历记录中获得了关于患者整体健康状况的详细信息。对每位参与者进行了探诊深度(PD)、临床附着丧失(CAL)、牙龈退缩(REC)、全口出血评分(FMBS)和菌斑评分(FMPS)的筛查。通过全景 X 射线图像确定骨丧失,其为牙骨质釉质交界处到牙槽嵴的距离(CEJ-AC)。从每组中接受牙周手术治疗的前 15 名患者中获取牙龈活检,并通过光学显微镜和直接免疫荧光分析来研究抗原-抗体复合物的沉积。11 名(44%)患者被诊断为活动期系统性红斑狼疮(SLE-A),14 名(56%)为非活动期系统性红斑狼疮(SLE-I)。SLE+的 PD、CAL 和 FMBS 均显著低于 SLE-(<0.05;Mann Whitney)。慢性低剂量免疫抑制剂的使用与 CAL>3mm 的发生率较低相关。与 SLE-相比,即使存在牙周炎,SLE+的狼疮肾炎和/或蛋白尿标志物的免疫荧光染色也明显增加。这些发现表明,SLE 中的免疫调节剂可改善牙周参数。在被诊断为 SLE 的患者的牙龈组织中,抗原-抗体复合物的更大沉积可能是疾病活动的标志物,可能有助于其诊断。