Association between Systemic Lupus Erythematosus andPeriodontitis: A Systemic Review and Meta-analysis. INTRODUCTION: Systemic lupus erythematosus is amulti-systemic autoimmune, chronic inflammatory disorder with clinicalmanifestations, affecting joints, internal organs, and the skin. (1)Periodontitis is an infection by abacterium that is present in dental biofilm characterized by chronicinflammation and is often associated with destruction of alveolar bone andconnective tissue.
(2) The inflammation severity may vary among people perhapsthe etiology of SLE is incomplete but it is a thought that in geneticallyprimed individuals in whom the inflammation response is triggered out byenvironmental stimulus. Independently degree of bacterial infections suggestingthat dysregulation of the host may substantially contribute to its extent. Thesecould be irreversible damage to the tissues and alveolar bone. Periodontaldisease possessing an important factor on oral health programs among worldwide.(3) On the other hand SLE is affecting cellular metabolism of connectivetissues, presenting with exacerbations and alternate periods of remission.(4-5) Oralmanifestations of SLE are common and typically take the form painless oralulcers that are frequently present during disease flares and are included incurrent SLE classification criteria.
(6) In the etiology of other chronicinflammatory autoimmune conditions, increasing the interest to the possiblerole of microbiota imbalance (dysbiosis), including SLE. For the betterunderstanding of association between SLE and periodontitis expand the currentknowledge of etiology of SLE which could lead to management strategies. Strongevidences had shown association between oral dysbiosis and periodontitisspecifically with rheumatoid arthritis. Appropriate treatments areimmunosuppressant medications, but are limited in efficacy and with multipleside effects which may lead to mortality and morbidity. Oral manifestations ofSLE are most common and typical that may occur in the form of painless oralulcers which are frequent presentation while disease flares and included incurrent SLE classification criteria. (7) Remarkable prevalence of periodontitishas been detected in SLE, and observed in almost 70% of the patients.(8-9-10-11)In this review, wehypothesized that there may be an association between SLE and periodontitis. Toevaluate this hypothesis, we conducted a systematic review and meta-analysis ofrelevant publications.
MATERIALS AND METHODS The protocol was written and submitted in the month ofDecember 2017. We used the preferred reporting system for systematic review andmeta-analyses Prisma check list (12) Eligibility Criteria for Population Studies which included participant of age 18 years or above.Both genders are included. Participants in the study must be diagnosed with SLEon the criteria of ACR American Collegeof rheumatology. Definition of systemic lupus erythematosus by American College of Rheumatology (13) or clinicaldiagnosis by a rheumatologist. Eligibility Criteria for study To be included, studies needed to be case-control,observational studies of cross-sectional, or cohort design. Conferenceproceedings and journal articles were included. Review articles, case reports,animal studies, and the studies with fewer than 18 years of patients and thosewith unavailable abstracts were excluded.
Grey literature was included whichmeets the inclusion criteria and exclusion criteria. There were no restrictionson date of publication or publication status. OUTCOME MEASURES To be included, prevalence of periodontitis usingstandardized measures needed to be reported in both SLE population and non-SLEpopulation. Search strategy MEDLINE via OVID, EMBASE via OVID, Lliac and PsycINFO viaOVID databases were searched using the following terms: systemic lupuserythematosus, SLE, lupus erythematosus, systemic or lupus nephritis, lupusvasculitis and Periodont*, gum disease, gingivitis, tooth decay, oral health,dental health, oral plaque index (PI), probing pocket depth, bleeding onprobing (BOP), and clinical attachment loss (CAL).
In addition, Google Scholarwas searched using the following term “Periodontitis and systemic lupuserythematosus.” The searches were re-run just before the final analyses on the03/08/2017 1. Tsokos GC.Systemic lupus erythematosus. N Engl J Med (2011) 365:2110–21.Doi:10.
1056/NEJMra1100359 2. Flemming TF (1999) Periodontitis. Ann Periodontal4(1):32-883. J.M. Albandar, H.
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Novo E,Garcia-MacGregor E, Viera N, Chaparro N, Crozzoli Y (1999) Periodontitis andAnti-neutrophil cytoplasmic antibodies in systemic lupus erythematosus andrheumatoid arthritis: a comparative study. J Periodontal 70(2)185-188.11.
Kobayashi T, I toS, Yamamoto K, Hasegawa H, Sugita N, Kuroda T, Kaneko S, Narita I, Yasuda K,Nakano M, Gejyo F, Yoshie H (2003) Risk of periodontitis in systemic lupuserythematosus in associated with Fegamma receptor polymorphisms. J Periodontal 74(3):378-384.12. https://www.ncbi.
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