Periodontitis is associated with disease severity and anti-double stranded DNA antibody and interferon-gamma levels in patients with systemic lupus erythematosus

Comparative study of the profile of supragingival dental plaque and tooth decay in patients with lupus erythematosus and rheumatoid arthritis

BACKGROUND AND OBJECTIVES

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are complex autoimmune diseases that present with a range of systemic and oral manifestations including dental decay and alterations in the oral microbiome profile. The purpose of this study was to compare the fungal and bacterial profile of supragingival dental plaque and dental caries in patients with SLE and RA.

METHODS

The present descriptive-cross-sectional-analytical study was conducted on 91 participants (31 RA, 30 lupus, and 30 control groups). Decayed, Missing, and Filled teeth (DMFT) and The International Caries Detection Assessment System (ICDAS) indices were used to investigate tooth decay. The DAS-28 index was used to assess the severity of RA, and the SLEDAI-2 K index was used to evaluate the severity of lupus. The number of supragingival dental plaque Streptococcus mutans, Lactobacillus spp. and Candida albicans colonies were evaluated using Mitis Salivarius Agar (MSA), deMan-Rogosa-Sharpe agar (MRS) and Sabouraud Dextrose Agar with Chloramphenicol (SC) culture medium, respectively. Data were analyzed using one-way ANOVA, Kruskal -Wallis, k2, Fisher's tests, and Spearman's correlation coefficient.

RESULTS

A statistically significant relationship was observed between the education level (P = 0.030), mean of DMFT, ICDAS, MSA and SC indices (P < 0.001) with the type of disease. The control and RA group showed significantly higher MRS index than the lupus group (P < 0.001). There was significant and positive correlation between the severity of the disease in lupus patients and SC (Candida albicans) (P < 0.001, R = 0.698) and MRS (P = 0/020, R = 0.408) indices.

CONCLUSION

Dental decay and the fungal and bacterial flora of supragingival dental plaque patients are higher than in the healthy group. It is recommended that these patients pay more attention to their oral hygiene and undergo periodic oral examinations.

Higher odds of periodontitis in systemic lupus erythematosus compared to controls and rheumatoid arthritis: a systematic review, meta-analysis and network meta-analysis

Introduction

Periodontitis as a comorbidity in systemic lupus erythematosus (SLE) is still not well recognized in the dental and rheumatology communities. A meta-analysis and network meta-analysis were thus performed to compare the (i) prevalence of periodontitis in SLE patients compared to those with rheumatoid arthritis (RA) and (ii) odds of developing periodontitis in controls, RA, and SLE.

Methods

Pooled prevalence of and odds ratio (OR) for periodontitis were compared using meta-analysis and network meta-analysis (NMA).

Results

Forty-three observational studies involving 7,800 SLE patients, 49,388 RA patients, and 766,323 controls were included in this meta-analysis. The pooled prevalence of periodontitis in SLE patients (67.0%, 95% confidence interval [CI] 57.0-77.0%) was comparable to that of RA (65%, 95% CI 55.0-75.0%) (p>0.05). Compared to controls, patients with SLE (OR=2.64, 95% CI 1.24-5.62, p<0.01) and RA (OR=1.81, 95% CI 1.25-2.64, p<0.01) were more likely to have periodontitis. Indirect comparisons through the NMA demonstrated that the odds of having periodontitis in SLE was 1.49 times higher compared to RA (OR=1.49, 95% CI 1.09-2.05, p<0.05).

Discussion

Given that RA is the autoimmune disease classically associated with periodontal disease, the higher odds of having periodontitis in SLE are striking. These results highlight the importance of addressing the dental health needs of patients with SLE.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/ identifier CRD42021272876.

Periodontitis and Systemic Lupus Erythematosus: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the association between periodontitis (PD) and systemic lupus erythematosus (SLE). A systematic search was conducted through the following electronic databases: Cochrane Library, MEDLINE, EMBASE, Scopus, LILACS, CINAHL and SIGLE (System for Information on Grey Literature in Europe) for relevant publications up to September 2020 with no language restriction. The association between PD and SLE was assessed by the prevalence of PD in SLE patients (both sex and females only) as the primary outcome. Secondary outcomes included differences in common gingival parameters including probing pocket depth (PPD), clinical attachment level (CAL), disease activity index (SLEDAI) scores of SLE patients with or without PD. A total of 1183 citations and 22 full text articles were screened. Eighteen articles were included in the qualitative synthesis, and 13 in the quantitative analysis. SLE diagnosis was associated with greater odds of PD (OR = 1.33, 95% Confidence Interval [CI]: 1.20-1.48), but these were non-significant when examined in females (OR = 3.20, 95%CI: 0.85-12.02). Patients with SLE exhibited no differences in PPD (SMD: -0.09 mm, 95%CI: -0.45-0.27) and CAL (SMD: 0.05 mm, 95%CI: -0.30-0.40) when compared with systemically healthy controls. PD diagnosis was, however, associated with higher SLEDAI scores in patients suffering from SLE (SMD: 0.68, 95% CI: 0.03-1.32). PD and SLE are both inflammatory diseases and their association could be bi-directional. This review suggested that the patients with SLE have greater odds of suffering with PD. Further investigations are required to assess the association between PD and SLE.

Prevalence of oral mucosal lesions, dental caries, and periodontal disease among patients with systemic lupus erythematosus in a teaching hospital in Chennai, Tamil Nadu

Background

The presence of oral symptoms and signs in many systemic diseases is not uncommon knowledge. Investigations that explore the relationship between systemic diseases and their oral manifestations are of particular interest to dentists, as this enables them to be better clinicians with an acumen to recognize, treat, or refer patients with the systemic disease to general physicians. This study was undertaken to understand the oral manifestations of systemic lupus erythematosus (SLE) with an emphasis on oral mucosal lesions, dental caries, and periodontitis.

Methods

A single institutional cross-sectional survey was conducted from September 2017 to July 2018 on a sample of 500 SLE patients attending the Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Chennai. The dentition status, periodontal status, and oral mucosal lesions were assessed by a single trained and calibrated examiner using the World Health Organization (WHO) proforma, 2013. Besides, disease activity in SLE patients was assessed by rheumatologists using the SLEDAI index with a cutoff score of more than 4 indicating the presence of active disease. Demographic characteristics including age, gender, occupation, monthly income, and education status were assessed using a questionnaire. Data were entered into an Excel Sheet and all statistical analyses were performed using SPSS for Windows version 20.0 (SPSS Inc., Chicago, IL, USA).

Results

In the present study, the prevalence of dental caries was found to be 87.6% in patients with SLE. The prevalence of severe periodontitis defined as the presence of at least one tooth with a 6 mm or deeper pocket was found to be 85% and the prevalence of oral mucosal lesions was found to be 86%. The prevalence percentage for dental caries, periodontal disease, and oral mucosal lesions were found to be higher than the rates reported for the general population in India. Patients with active SLE had a higher prevalence of dental caries, periodontitis, and oral mucosal lesions than patients with inactive SLE.

Conclusion

It can be concluded from the present study that SLE patients are more vulnerable to oral diseases than the general population. Furthermore, disease activity in SLE patients has a strong positive correlation with oral health status in SLE patients.

Role of Lymphocytes CD4/CD8 Ratio and Immunoglobulin G Cytomegalovirus as Potential Markers for Systemic Lupus Erythematosus Patients with Periodontal Disease

Objectives  The aim of the study was to analyze the correlation between periodontitis severity in systemic lupus erythematosus (SLE) with CD4/CD8 lymphocytes ratio and cytomegalovirus gamma immunoglobulin (IgG CMV) level.

Materials and Methods  This is a descriptive study using a cross-sectional approach that included 93 subjects who were diagnosed with SLE in Rheumatology Department, Saiful Anwar Hospital, during 2017 to 2019. Periodontitis severity was assessed by periodontal Index (PI). CD4/CD8 lymphocyte ratio was determined using flow cytometry and IgG CMV levels using enzyme-linked immunosorbent assay.

Statistical Analysis  The differences among the three groups were analyzed using analysis of variance. Correlation among the groups was calculated using Spearman/Pearson correlation coefficient test, while regression analysis was done using Statistical Package for the Social Sciences.

Results  The mean of periodontitis severity and standard deviation in SLE was 2.66 ± 1.02. There were negative correlation between CD4/CD8 lymphocyte ratio with periodontal index ( r = –0.971) and positive correlation between IgG CMV level with periodontal index ( r = 0.977).

Conclusions  Inverted CD4/CD8 ratio and IgG CMV were found associated with periodontitis severity in SLE patient. Further research was recomended that CD4/CD8 lymphocytes ratio and IgG CMV can be used as a potensial marker of periodontitis severity in SLE patients.