Perda dentária como preditor de complicações e prognósticos em pacientes com artrite reumatoide

Abstract

Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease that manifests in the oral cavity primarily through the development and progression of periodontal disease (PD), an inflammatory condition in the oral cavity that has a bidirectional relationship with rheumatologic disease and other systemic conditions, and can gradually lead to tooth loss (TL). Given this relationship, the study aimed to evaluate and analyze oral health conditions and tooth loss in RA patients to determine whether the number of missing teeth could be used as an additional useful indicator for the medical team, predicting exacerbations of the systemic disease. A crosssectional study was conducted involving RA patients assessed according to specific protocols and instruments. Medical records were reviewed, providing demographic data, medical and rheumatologic history, and medications used by each patient. A systematic orofacial assessment was carried out, validated questionnaires were administered, and indices of rheumatologic disease activity and functional capacity (DAS-28 and HAQ) were collected. After obtaining all the data, they were statistically analyzed. The study included 21 patients aged between 31 and 74 years, with 7 (33.4%) in remission of RA and 14 (66.6%) exhibiting some level of disease activity. Among these patients, 10 (47%) had moderate to severe disability caused by RA. Statistical analyses revealed that patients on polypharmacy (mean rank = 12.87) tended to have a greater number of missing teeth compared to those using fewer medications (mean rank = 6.33) (U = 17, df = 1, p = 0.029), and there was a higher Carious, Missing, and Filled Teeth (DMF-T) index value in patients with some degree of rheumatologic disease activity. Correspondence analysis indicated that patients on polypharmacy had a higher prevalence of moderate to severe disability as assessed by HAQ, along with moderate to high DMF-T scores. It is concluded that there is a relationship between the DMF-T index, RA activity, the number of missing teeth, and the need for polypharmacy, making these data important to be assessed in the clinical routine of RA patients.