O impacto do lúpus eritematoso sistêmico juvenil na inflamação gengival: achados clínicos, imunológicos e microbiológicos

• Autor(a) principal: Sete, Manuela Rubim Camara
• Data de Publicação: 2018
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/14062
• topic: Gingivitis; Juvenile systemic lupus erythematosus; Cytokines; Antibodies; Dysbiosis; Gengivite; Lúpus eritematoso sistêmico juvenil; Citocinas; Anticorpos; Disbiose; CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA::PERIODONTIA

The objectives of this study were to evaluate the expression of cytokines in serum and gingival fluid, the production of arginine-peptidyl-deiminase (anti-PPAD) and the microbiological profile of patients with juvenile systemic lupus erythematosus (jSLE) and compare with systemically healthy individuals. As a secondary objective, we evaluated the impact of treatment of gingival inflammation on cytokine expression and anti-PPAD levels. Thirty patients with jSLE (mean age: 16.2 ± 1.5 years) and 29 without systemic disease (mean age 15.5 ± 2.3 years), both with gingivitis, participated in the study. Rheumatological and periodontal data, blood, gingival fluid and intrassulcular biofilm were collected. Cytokines were analyzed by multiplex multi-assay; anti-PPAD by enzyme-linked immunosorbent assay (ELISA) and bacterial levels by checkerboard DNA-DNA hybridization. Pearson's Chi-square test was used to evaluate categorical variables; Mann-Whitney U test for numerical variables and Kendall's tau-b statistic for correlations. In longitudinal study, McNemar test was used for qualitative data, and Wilcoxon test for numerical data. In cross-sectional study, test group presented higher levels of probing depth (PD), clinical attachment level (CAL), % of plaque and bleeding than control group. In serum analysis, G-CSF were significantly higher and TNF-α significantly lower in test group. In analysis of gingival fluid, IL-1β, IL-7, IL-8, IL-13, G-CSF, IFN-γ and MCP-1 were significantly higher and IL-4, IL-12(p70) and GM-CSF were significantly lower in test group. There was no significant difference in anti-PPAD levels between groups. S. constellatus, A. actinomycetencomytans, E. saburreum, V. parvula, S. intermedius, C. showae and F. nucleatum were significantly more numerous in test group and A. gerencseriae and T. denticola in control group. After treatment of gingival inflammation, SLEDAI, % CAL 1-2 and CAL decreased significantly. Already the values of PD and % CAL 0 increased. In serum, there was a significant decrease in IL-4 and IL-5 and a significant increase in anti-PPAD levels after treatment. In gingival fluid, there was a significant decrease in IL-1β, IL-10 and MCP-1 and significant increase in IL-4, IL-12 (p70), IL-17, GM-CSF and INF-α. Thus, we can conclude that patients with jSLE presented worse periodontal conditions, PBS, NIC, % plaque and bleeding than systemically healthy patients. Cytokine analysis showed an increase in serum G-CSF and TNF-α and IL-1β, IL-7, IL-8, IL-13, G-CSF, IFN-γ and MCP-1 in gingival fluid of patients with jSLE. Anti-PPAD antibodies have been identified in patients with jSLE, which may serve as a trigger for impaired immune tolerance. Longitudinal interventional study demonstrated that treatment of gingival inflammation significantly improved % CAL 1-2 and CAL parameters. There was a small, but significant worsening in PBS, which we believe has no clinical relevance. We also observed a significant improvement in SLEDAI and levels of IL-4 and IL-5 in serum and an increase in cytokines IL-12, IL-17 and GM-CSF in gingival fluid. Regarding the anti-PPAD antibody, we observed a significant increase after the treatment of gingival inflammation.