Persistent Periodontal Disease Hampers Anti-Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis

Autor(es)

Savioli, Cynthia ^[1] ; Ribeiro, Ana Cristina M. ^[2] ; Campos Fabri, Gisele Maria ^[1] ; Calich, Ana Luisa ^[2] ; Carvalho, Jozelio ^[2] ; Silva, Clovis A. ^[3] ; Viana, Vilma S. T. ^[2] ; Bonfa, Eloisa ^[2] ; Siqueira, Jose Tadeu T. ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Dent Div, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Div Rheumatol, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Paediat Rheumatol Unit, Hosp Clin, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JCR-JOURNAL OF CLINICAL RHEUMATOLOGY; v. 18, n. 4, p. 180-184, JUN 2012.
• Citações Web of Science: 35

Resumo

Objective: This study aimed to evaluate prospectively the influence and the evolution of periodontal disease (PD) in rheumatoid arthritis (RA) patients submitted to anti-tumor necrosis factor (TNF) therapy. Methods: Eighteen patients with RA (according to the American College of Rheumatology criteria) were assessed for PD before (BL) and after 6 months (6M) of anti-TNF treatment: 15 infliximab, 2 adalimumab, and 1 etanercept. Periodontal assessment included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Rheumatologic evaluation was performed blinded to the dentist's assessment: demographic data, clinical manifestations, and disease activity (Disease Activity Score using 28 joints {[}DAS28], erythrocyte sedimentation rate {[}ESR], and C-reactive protein {[}CRP]). Results: The median age and disease duration of patients with RA were 50 years (25-71 y) and 94% were female. Periodontal disease was diagnosed in 8 patients (44.4%). Comparing BL to 6M, periodontal parameters in the entire group remained stable (P > 0.05) throughout the study (plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level), whereas an improvement in most analyzed RA parameters was observed in the same period: DAS28 (5.5 vs. 3.9, P = 0.02), ESR (21 vs. 12.5 mm/first hour, P = 0.07), and CRP (7.8 vs. 2.8 mg/dL, P = 0.25). Further analysis revealed that this improvement was restricted to the group of patients without PD (DAS28 {[}5.5 vs. 3.6, P = 0.04], ESR {[}23.0 vs. 11.5 mm/first hour, P = 0.008], and CRP {[}7.4 vs. 2.1, P = 0.01]). In contrast, patients with PD had lack of response, with no significant differences in disease activity parameters between BL and 6M: DAS28 (5.2 vs. 4.4, P = 0.11), ESR (17.0 vs. 21.0, P = 0.56), and CRP (9.0 vs. 8.8, P = 0.55). Conclusions: This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition. (AU)

• Processo FAPESP: 10/12035-5 - Terapia anti-TNF em doenças auto-imunes reumatológicas: abordagem de aspectos peculiares
• Beneficiário: Gisele Maria Campos Fabri
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado