Association between Systemic Lupus Erythematosus and
Periodontitis: A Systemic Review and Meta-analysis.
Systemic lupus erythematosus is a
multi-systemic autoimmune, chronic inflammatory disorder with clinical
manifestations, affecting joints, internal organs, and the skin. (1)
Periodontitis is an infection by a
bacterium that is present in dental biofilm characterized by chronic
inflammation and is often associated with destruction of alveolar bone and
connective tissue. (2) The inflammation severity may vary among people perhaps
the etiology of SLE is incomplete but it is a thought that in genetically
primed individuals in whom the inflammation response is triggered out by
environmental stimulus. Independently degree of bacterial infections suggesting
that dysregulation of the host may substantially contribute to its extent. These
could be irreversible damage to the tissues and alveolar bone. Periodontal
disease possessing an important factor on oral health programs among worldwide.
(3) On the other hand SLE is affecting cellular metabolism of connective
tissues, presenting with exacerbations and alternate periods of remission.
manifestations of SLE are common and typically take the form painless oral
ulcers that are frequently present during disease flares and are included in
current SLE classification criteria. (6) In the etiology of other chronic
inflammatory autoimmune conditions, increasing the interest to the possible
role of microbiota imbalance (dysbiosis), including SLE. For the better
understanding of association between SLE and periodontitis expand the current
knowledge of etiology of SLE which could lead to management strategies. Strong
evidences had shown association between oral dysbiosis and periodontitis
specifically with rheumatoid arthritis. Appropriate treatments are
immunosuppressant medications, but are limited in efficacy and with multiple
side effects which may lead to mortality and morbidity. Oral manifestations of
SLE are most common and typical that may occur in the form of painless oral
ulcers which are frequent presentation while disease flares and included in
current SLE classification criteria. (7) Remarkable prevalence of periodontitis
has been detected in SLE, and observed in almost 70% of the patients.
In this review, we
hypothesized that there may be an association between SLE and periodontitis. To
evaluate this hypothesis, we conducted a systematic review and meta-analysis of
MATERIALS AND METHODS
The protocol was written and submitted in the month of
December 2017. We used the preferred reporting system for systematic review and
meta-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 SLE
on the criteria of ACR
of rheumatology. Definition of systemic lupus erythematosus by American College of Rheumatology (13) or clinical
diagnosis by a rheumatologist.
Eligibility Criteria for study
To be included, studies needed to be case-control,
observational studies of cross-sectional, or cohort design. Conference
proceedings and journal articles were included. Review articles, case reports,
animal studies, and the studies with fewer than 18 years of patients and those
with unavailable abstracts were excluded. Grey literature was included which
meets the inclusion criteria and exclusion criteria. There were no restrictions
on date of publication or publication status.
To be included, prevalence of periodontitis using
standardized measures needed to be reported in both SLE population and non-SLE
MEDLINE via OVID, EMBASE via OVID, Lliac and PsycINFO via
OVID databases were searched using the following terms: systemic lupus
erythematosus, SLE, lupus erythematosus, systemic or lupus nephritis, lupus
vasculitis and Periodont*, gum disease, gingivitis, tooth decay, oral health,
dental health, oral plaque index (PI), probing pocket depth, bleeding on
probing (BOP), and clinical attachment loss (CAL). In addition, Google Scholar
was searched using the following term “Periodontitis and systemic lupus
erythematosus.” The searches were re-run just before the final analyses on the
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