Is there an association between systemic lupus erythematosus and periodontal disease?

Calderaro, Débora Cerqueira; Ferreira, Gilda Aparecida; Mendonça, Santuza Maria Souza de; Corrêa, Jôice Dias; Santos, Fabrícia Xavier; Sanção, João Guilherme Capinam; Silva, Tarcília Aparecida da; Teixeira, Antônio Lúcio

doi:10.1016/j.rbre.2015.08.003

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Sumário

Brief Communication • Rev. Bras. Reumatol. 56 (3) • May-Jun 2016 • https://doi.org/10.1016/j.rbre.2015.08.003 copy

Is there an association between systemic lupus erythematosus and periodontal disease?^☆ ☆ Study linked to the Medicine School and Dental School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Periodontal disease results from the interaction between pathogenic bacteria that colonize supragingival and subgingival biofilms and the host, triggering an inflammatory response, with systemic effects leading to immune-mediated destruction of the attachment apparatus and loss of supporting alveolar bone. Immunological pathways and predisposing genetic factors common to periodontal disease and rheumatic diseases, including systemic lupus erythematosus, have been described. Case reports have suggested greater severity of periodontal disease in patients with systemic lupus erythematosus. However, studies evaluating the influence of the treatment of one disease on the clinical and laboratory manifestations of the other have yielded conflicting results.

Keywords
Systemic lupus erythematosus; Periodontitis; Chronic periodontitis

Study	Number of patients with SLE	Frequency of periodontitis observed	Frequency of periodontitis in general population
Rhodus and Johnson⁶6 Rhodus NL, Johnson DK. The prevalence of oral manifestations of systemic lupus erythematosus. Quintessence Int. 1990;21:461-5.	16	93.8%	Not reported
Novo et al. ⁷7 Novo E, MacGregor EG, Nava S, Perini L. A possible defective estimation of antineutrophil cytoplasmic antibodies in systemic lupus erythematosus due to the coexistence of periodontitis: preliminar observations. PRJSJ. 1997;16:369-73.^,⁸8 Novo E, Garcia-MacGregor E, Vieira N, Chaparro N, Crozzoli Y. Periodontitis and anti-neutrophil cytoplasmic antibodies in systemic lupus erythematosus and rheumatoid arthritis: a comparative study. J Periodontol. 1999;70:185-8.	30	60%	Not reported
Kobayashi et al. ⁹9 Kobayashi T, Ito S, Yamamoto K, Hasegawa H, Sugita N, Kuroda T, et al. Risk of periodontitis in systemic lupus erythematosus is associated with Fcγreceptor polymorphisms. J Periodontol. 2003;74:378-84.	60	70%	30-40%
Kobayashi et al. ¹⁰10 Kobayashi T, Ito S, Yasuda K, Kuroda T, Yamamoto K, Sugita N, et al. The combined genotypes of stimulatory and inhibitory Fc γreceptors associated with systemic lupus erythematosus and periodontitis in Japanese adults. J Periodontol. 2007;78:467-74.	71	64.8%	Not reported
Fabbri et al. ¹¹11 Fabbri C, Fuller R, Bonfá E, Guedes LK, D’Alleva PS, Borba EF. Periodontitis treatment improves systemic lupus erythematosus response to immunosuppressive therapy. Clin Rheumatol. 2014;33:505-9.	55	89%	Not reported

Study	Study design	Patients included	Assessed outcomes	Results
Mutlu et al.¹⁴14 Mutlu S, Richards A, Maddison P, Scully C. Gingival and periodontal health in systemic lupus erythematosus. Community Dent Oral Epidemiol. 1993;21:158-61.	Case-control	27 SLE 25 controls	PPD	Lower in SLE.
Meyer et al.¹²12 Meyer U, Kleinheinz J, Handschel J, Kruse-Lösler B, Weingart D, Joos U. Oral findings in three different groups of immunocompromised patients. J Oral Pathol Med. 2000;29:153-8.	Case-control	46 SLE 50 controls	VPI, GBI, BOP%	Similar.
Kobayashi et al.⁹9 Kobayashi T, Ito S, Yamamoto K, Hasegawa H, Sugita N, Kuroda T, et al. Risk of periodontitis in systemic lupus erythematosus is associated with Fcγreceptor polymorphisms. J Periodontol. 2003;74:378-84.	Case-control	42 SLE + PD 42 PD	PPD, CAL, SP%, BOP%	Smaller PPD, CAL and BOP% in SLE. Similar SP% and BOP%.
Souza¹³13 Souza AA. Condições periodontais em pacientes com lúpus eritematoso sistêmico juvenil. Tese apresentada à Faculdade de Odontologia da UERJ, como requisito para obtenção do título de Doutora em Periodontia, Rio de Janeiro; 2006. p. 70.	Case-control	16 JSLE 14 controls	VPI, GBI, CAL, PPD	Lower percentage of sites with PPD ≥3 mm in JSLE. Similar VPI, GSI and percentage of sites with CAL ≥2 mm. Active JSLE presented higher VPI and GSI versus inactive JSLE.
Miceli et al.¹⁵15 Miceli VC, Braga F, Áreas A, Figueredo CMS, Sztajnbok F, Fischer RG. Condições clínicas e níveis de IL1-β em pacientes adolescentes com lúpus eritematoso sistêmico. R Periodontia. 2006;16:21-7.	Case-control	17 JSLE 14 controls	PPD	Lower percentage of sites with PPD ≥4 mm in SLE.
Kobayashi et al.¹⁰10 Kobayashi T, Ito S, Yasuda K, Kuroda T, Yamamoto K, Sugita N, et al. The combined genotypes of stimulatory and inhibitory Fc γreceptors associated with systemic lupus erythematosus and periodontitis in Japanese adults. J Periodontol. 2007;78:467-74.	Case-control	46 SLE + PD 48 PD	PPD, CAL, BOP%, SP%	Lower PPD, CAL, BOP%, and SP% in SLE. Similar SP%.
Fernandes et al.¹⁶16 Fernandes EGC, Saviolli C, Siqueira STT, Silva CAA. Oral health and the masticatory system in juvenile systemic lupus erythematosus. Lupus. 2007;16:713-9.	Case-control	48 JSLE 48 controls	VPI, GBI	Higher in JSLE. Cumulative prednisone dosage correlated to VPI and GBI.
Umbelino Jr. et al.¹⁷17 Umbelino AA, Cantisano MH, Klumb EM, Dias EP, Silva AA. Achados bucais e laboratoriais em paciente com lúpus eritematoso sistêmico. J Bras Patol Med Lab. 2010;46:479-86.	Case series	155 SLE	Dental calculus, gingival bleeding, periodontal pockets.	Gingival bleeding and periodontal pockets were greater in SLE patients, when compared to epidemiological data from general population.
Meyer et al.¹⁸18 Meyer U, Kleinheinz J, Gaubitz M, Schulz M, Weingart D, Joos U. Oral manifestations in patients with systemic lupus erythematosus. Mund Kiefer Gesichtschir. 1997;1:90-4. [abstract].	Case series	46 SLE	Oral mucosa lesions, teeth loss, gingival inflammation.	Greater in patients with severe SLE.
Sales et al.²⁰20 Sales LAR, Chaves MGAM, Vassalo S. Efeito do tratamento periodontal na condição do periodonto e na atividade inflamatória sistêmica em portadores de lúpus eritematoso sistêmico. Rev Int Est Exp. 2010;2:94-9.	Series of cases submitted to clinical treatment of PD.	6 SLE + PD	Bacterial plaque, BOP% and PPD, SLEDAI, CRP.	Improvement of periodontal parameters with no changes of SLEDAI.
Fabbri et al.¹¹11 Fabbri C, Fuller R, Bonfá E, Guedes LK, D’Alleva PS, Borba EF. Periodontitis treatment improves systemic lupus erythematosus response to immunosuppressive therapy. Clin Rheumatol. 2014;33:505-9.	Randomized, controlled trial on PD treatment.	49 SLE + PD: 32 treated 17 untreated	PPD, CAL, GBI, SLEDAI, CRP, ESR.	Improvement of periodontal parameters and SLEDAI on treatment group

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[1] *Corresponding author. E-mail:dccalderaro@gmail.com, dccalderaro@hotmail.com (D.C. Calderaro).

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Is there an association between systemic lupus erythematosus and periodontal disease?☆ ☆ Study linked to the Medicine School and Dental School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Abstract

Is there an association between systemic lupus erythematosus and periodontal disease?^☆ ☆ Study linked to the Medicine School and Dental School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.