Periodontitis treatment improves systemic lupus erythematosus response to immunosuppressive therapy

Abstract

Periodontal disease (POD) may affect rheumatic diseases severity, but there are no data regarding the effect of its treatment on disease activity in SLE patients under immunosuppressive therapy. Forty-nine consecutive SLE patients (SLEDAI ≥ 2) with POD and under corticosteroid and cyclophosphamide pulse therapy (IVCYC) were selected. Periodontal assessment included bleeding gingival index (BGI), probing depth (PD), and probing attachment level (PAL). At entry, POD was defined as BGI > 1 and patients were assigned to groups according to the availability of odontological intervention in TREATED (n = 32) and NOT TREATED (n = 17). SLEDAI and POD parameters were determined at entry and after 3 months. Age, female gender, and race were alike among TREATED and NOT TREATED (p > 0.05). Both groups had also comparable disease duration (10.7 ± 6.8 vs. 11.0 ± 6.6, p = 0.83), IVCYC number (5.8 ± 4.8 vs. 4.5 ± 4.8, p = 0.17), and SLEDAI (5.9 ± 4.2 vs. 6.3 ± 4.3, p = 0.73) as well as POD parameters [BGI (40.8 ± 31.0 vs. 40.7 ± 36.2 %, p = 0.89), PD (1.7 ± 1.8 vs. 1.5 ± 0.60 mm, p = 0.80), and PAL (2.5 ± 1.9 vs. 1.9 ± 1.1 mm, p = 0.18)]. At the end of the study, TREATED group had a significant improvement in SLEDAI (5.9 ± 4.2 vs. 3.4 ± 3.3, p = 0.04) with a paralleled reduction in BGI (40.8 ± 31.0 vs. 15.2 ± 17.2 %, p < 0.01), PD (1.7 ± 1.8 vs. 1.1 ± 0.3 mm, p < 0.01), and PAL (2.5 ± 1.9 vs. 1.7 ± 0.9 mm, p < 0.01). In contrast, SLEDAI (6.3 ± 4.3 vs. 6.0 ± 5.5, p = 0.40) and POD parameters [BGI (p = 0.33), PD (p = 0.91), and PAL (p = 0.39)] remained largely unchanged in NOT TREATED group. Periodontal disease treatment seems to have a beneficial effect in controlling disease activity in SLE patients under immunosuppressive therapy. Therefore, management of this modifiable risk factor is recommended.

Subgingival microbiota dysbiosis in systemic lupus erythematosus: association with periodontal status

“…Therefore, chronic inflammatory conditions such as diabetes, obesity, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) are linked to an increased risk or severity of periodontal disease [6–11]. Furthermore, periodontitis might have an adverse effect by enhancing systemic inflammation and increasing the risk of myocardial infarction [12], preterm birth [7], pneumonia [13], stroke [14], and rheumatoid arthritis [15] as well as worsen SLE severity [16]. …”

Possible evidence of systemic lupus erythematosus and periodontal disease association mediated by Toll-like receptors 2 and 4

“…Periodontal disease may also be related to worsening of SLE through expression of cytokines, and periodontal disease treatment seems to have a beneficial effect in controlling disease activity in SLE [60]. The stimulation of the expression of both TLR-2 and TLR-4 in SLE patients might be influenced at least partially by periodontal disease which, due to the influence of microorganisms involved in the chronic inflammatory process related to their disease process, could stimulate the activation mechanisms of autoimmunity related to SLE.…”

“…The stimulation of the expression of both TLR-2 and TLR-4 in SLE patients might be influenced at least partially by periodontal disease which, due to the influence of microorganisms involved in the chronic inflammatory process related to their disease process, could stimulate the activation mechanisms of autoimmunity related to SLE. Given that periodontal treatment can reduce SLE disease activity [60], the persistence of the disease is probably a factor of immunological interference subject to further investigation. Studies with measurements of serum inflammatory markers levels could shed light on the link between the two factors (Fig.…”

The Impact of T Cell Vaccination in Alleviating and Regulating Systemic Lupus Erythematosus Manifestation

“…GC has been an essential therapy for SLE because it works effectively in anti-inflammatory and antiallergic reactions, as well as assisting in improving SLE response to immunosuppressive therapy [29]. However, an increasing number of reports have demonstrated glucocorticoid-induced damage, such as osteoporosis, diabetes, and hypertension [4, 12, 30, 31] due to long-term and high-dose use in the treatment of SLE.…”