Associação entre o lúpus eritematoso sistêmico e a periodontite crônica

Abstract

Introduction: Immunological pathways and predisposing genetic factors common to periodontal disease and systemic lupus erythematosus have been described. Studies evaluating the clinical and laboratory associations between periodontitis and, LES and influences of the treatment of each disease on the clinical and laboratory manifestations of the other have yielded conflicting results. Objectives: To compare the frequency and the severity of chronic periodontitis in SLE patients with subjects without rheumatic diseases and explore the relationship of periodontal status with clinical, laboratory and therapeutic variables of SLE patients. Patients and methods: Seventy-five SLE adult patients were compared to 75 subjects without rheumatic diseases (control group), matched for age, educational level and income. Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K) was used to measure SLE activity. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus (SLICC/ACR) was used to evaluate SLE associated damage. The dental evaluation included measurement of plaque index and parameters used in the evaluation of periodontal disease (probing depth, clinical attachment level and percentage of gingival sites presenting bleeding on probing). Five-minute basal and stimulated sialometry was performed and blood and saliva samples were collected. Results: Fifth-one (68%) SLE patients and 42 (56%) subjects in the control group had periodontitis (p=0.13). Considering the 93 subjects with periodontitis, SLE patients were younger than control group individuals (40.7 ± 9.8 versus 46.14 ± 12.5 years, p = 0.02). Periodontal parameters and the severity of periodontitis were similar in both groups. SLE patients with periodontitis were older, had a lower educational level, longer SLE duration, greater cumulative corticosteroids dosage and a lower stimulated sialometry than SLE patients without periodontitis. Patients with high SLE activity (SLEDAI 2 K 6) presented the same periodontal conditions of SLE less active or inactive. In the group of SLE patients, probing depth and clinical attachment level correlated to age, educational level, SLE duration and corticosteroid cumulative dosage. Clinical attachment level also correlated to SLICC/ACR. On multivariate analysis, only age was independently associated to periodontitis in SLE patients. Conclusions: Periodontitis frequency and severity were similar in SLE patients and in subjects of the control group. SLE patients with periodontitis were younger than control group participants with periodontitis. Periodontal parameters were associated with variables associated with SLE duration, cumulative corticosteroid dosage and SLICC/ACR, suggesting that periodontitis may increase the risk of damage in SLE.