Interação entre inflamação sistêmica e local na artrite reumatoide: evidências a partir do fluido crevicular gengival

Abstract

Introduction: Gingival crevicular fluid (GCF) is a relevant indicator in detecting periodontal inflammation, especially in subclinical stages and in patients with chronic diseases such as Rheumatoid Arthritis (RA). Objective: To quantitatively assess GCF, periodontal condition, and clinical parameters of Rheumatoid Arthritis (RA), comparing them to a control group (CG), and to verify the correspondence between systemic and dental aspects. Methodology: A cross-sectional study was conducted with consecutive RA patients treated at a public university hospital and controls matched by age, sex, and socioeconomic status. Demographic data, RA activity, functional capacity, anticholinergic burden, socioeconomic status, polypharmacy (PP), orofacial physical examination, and complete periodontal evaluation were assessed. GCF volume was measured using a Periotron® (Oralflow Inc., New York, NY, USA). Statistical analysis included parametric and non-parametric tests, as well as multiple correspondence analysis (MCA), with significance set at p<0.05. Results: A total of 33 patients were evaluated, 18 in the RA group and 15 in the control group. The mean age was 55 years in the RA group and 42 in the control group. Regarding the periodontal condition, 9 (50%) RA patients were diagnosed with periodontitis, with mean probing depth index (PDI) of 4%, plaque index (PI) 25.5%, and bleeding on probing (BOP) 30%. In contrast, 12 (80%) controls were diagnosed with gingivitis, with mean PDI of 1%, PI 32%, and BOP 34%, revealing worse periodontal status in RA patients, although GCF levels were similar between groups. The multivariate correspondence analysis showed a strong association between advanced periodontitis (stages III/IV grade B), high biofilm indices (PI >20%), gingival bleeding (BOP >10%), pocket depth >4 mm, and severe gingival inflammation (GCFs). These conditions coincided with higher rheumatologic activity (DAS28h), severe functional impairment (HAQs), use of biologics (bDMARDs), polypharmacy, and elevated anticholinergic activity (ADS≥3). Conversely, individuals with periodontal health and RA in remission showed low local and systemic inflammatory levels, less medication use and absence of immunosuppressive therapy. Intermediate cases were positioned between these extremes, indicating gradual progression and interdependence between oral and systemic manifestations. Conclusion: RA patients demonstrated greater periodontal impairment despite similar GCF levels compared to controls. Multivariate analysis revealed a strong association between periodontal severity, RA activity, polypharmacy, and elevated anticholinergic activity. Even with a limited number of patients, the findings highlight underexplored data in scientific literature, reinforcing the importance of integrated evaluation of systemic and oral conditions, and suggesting that GCF volume is implicated in the pathophysiological mechanisms of periodontal disease progression in RA.