Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
J Periodontal Res. 2021 Dec;56(6):1099-1115. doi: 10.1111/jre.12925. Epub 2021 Sep 12.
To evaluate the influence of diverse anti-rheumatic agents on the periodontal condition and to provide clinical medication guidance for patients with rheumatoid arthritis (RA) and periodontitis.
In recent years, the correlation between RA and periodontitis has become a hot research topic, but no medication recommendations for patients with RA and periodontitis are available at present.
The protocol of this review was registered in advance with PROSPERO (CRD42021248827). Electronic search and manual searches up to March 20, 2021 were conducted. The inclusion criteria for the studies were as follows: included patients diagnosed with periodontitis and RA submitted to anti-rheumatic agent therapy; with a control group receiving no anti-rheumatic agent therapy; with outcomes including at least one periodontal parameter. Probing depth (PD) and clinical attachment loss (CAL) were pooled using weighted mean difference (WMD) and 95% confidence intervals (CI) while gingival index (GI)/modified gingival index (MGI) was analyzed by standardized mean difference (SMD) and 95% CI.
One thousand four hundred and seventy-eight studies potentially related to the aim of this review were screened, but only 463 patients from 14 studies were included in the qualitative analysis, and 146 patients from 4 studies were included in the meta-analysis. Statistically significant reductions were observed among the subjects who received anti-rheumatic agents for PD [WMD = -0.20; 95% CI (-0.33, -0.07); effect p = .003; I = 50%; p = .11], CAL [WMD = -0.4; 95% CI (-0.66, -0.15); effect p = .002; I = 57%; p = .07] and GI/MGI [SMD = -0.61;95% CI (-0.94, -0.27; effect p = .0004; I = 26%; p = .25]. Consistent with the above results, this systematic review produced promising results that PD, CAL, GI/MGI, and bleeding on probing (BOP) decreased when patients with RA and periodontitis were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), anti-B lymphocyte agents, anti-IL-6R agents, or JAK inhibitors. PD and CAL declined after the administration of anti-TNF-α agents; most studies reported decreased GI/MGI and BOP, while 2 studies reported increased GI/MGI and BOP.
These results revealed that csDMARDs, anti-B lymphocyte agents, anti-IL-6R agents, anti-TNF-α agents, and JAK inhibitors had potential positive effects in improving the periodontal condition of patients with RA and periodontitis. However, future research is needed to elucidate whether anti-TNF-α agents have a side effect of increased gingival inflammation.
评估不同的抗风湿药物对牙周状况的影响，为类风湿关节炎（RA）和牙周炎患者提供临床用药指导。
近年来，RA 与牙周炎的相关性已成为热门研究课题，但目前尚无针对 RA 和牙周炎患者的用药推荐。
本研究方案已在 PROSPERO（CRD42021248827）上预先注册。截至 2021 年 3 月 20 日，进行了电子检索和手动检索。纳入研究的标准如下：纳入接受抗风湿药物治疗的诊断为牙周炎和 RA 的患者；纳入接受无抗风湿药物治疗的对照组；纳入至少有一个牙周参数的研究。使用加权均数差（WMD）和 95%置信区间（CI）汇总探诊深度（PD）和临床附着丧失（CAL），使用标准化均数差（SMD）和 95%CI 分析牙龈指数（GI）/改良牙龈指数（MGI）。
共筛选出 1478 项与本研究目的相关的研究，但仅有 14 项研究的 463 例患者纳入定性分析，4 项研究的 146 例患者纳入荟萃分析。接受抗风湿药物治疗的患者 PD [WMD=-0.20；95%CI（-0.33，-0.07）；效应 p=0.003；I²=50%；p=0.11]、CAL [WMD=-0.4；95%CI（-0.66，-0.15）；效应 p=0.002；I²=57%；p=0.07]和 GI/MGI [SMD=-0.61；95%CI（-0.94，-0.27）；效应 p=0.0004；I²=26%；p=0.25]明显降低。与上述结果一致，本系统评价得出了有前景的结果，即 RA 和牙周炎患者接受常规合成改善病情抗风湿药物（csDMARDs）、抗 B 淋巴细胞药物、抗白细胞介素 6R 药物或 JAK 抑制剂治疗后，PD、CAL、GI/MGI 和探诊出血（BOP）减少。抗 TNF-α 药物治疗后 PD 和 CAL 下降；大多数研究报告 GI/MGI 和 BOP 降低，而 2 项研究报告 GI/MGI 和 BOP 增加。
这些结果表明，csDMARDs、抗 B 淋巴细胞药物、抗白细胞介素 6R 药物、抗 TNF-α 药物和 JAK 抑制剂对改善 RA 和牙周炎患者的牙周状况具有潜在的积极作用。然而，仍需要进一步的研究来阐明抗 TNF-α 药物是否有增加牙龈炎症的副作用。
