periodontitis an occult source of recurrent infection in patients with systemic lupus erythematosus?

ABSTRACT

To determine if periodontitis can be considered as an occult source and septic focus for recurrent infections in patients with Systemic lupus erythematosus [SLE]. The present study was conducted on 60 subjects divided into 4 groups. Group 1 included 30 SLE patients with periodontitis [SLE/P]. They were further subdivided according to the CRP titer into Group 1A 20 patients with CRP titer > 6 and Group 1B 10 patients with CRP titer < 6. Group 2 included 10 SLE patients without periodontitis [SLE/X], Group 3 10 non SLE subjects with periodontitis [X/P] and lastly Group 4 10 healthy subjects. SLE disease activity was assessed by SLAM score. Periodontal examination was assessed by periodontal disease index [PDI]. Laboratory investigations serum [s] and salivary [sal] CRP titre, CBC, ESR and urine analysis. Microbiological examination of plaque specimens was done. Comparative study between Group 1A and Group 3 revealed a highly significant difference as regards PDI and a significant difference as regards WBC count, ESR, s/CRP, sal/CRP titre indicating more severe periodontal disease in patients with SLE. There was a highly significant greater severity of periodontal disease in patients additionally receiving immunosuppressive therapy. The plaque culture showed Streptococci, Klebsiella, Staphylococci, E. coli and Pneumococci. In selected patients from Group 1, there was a highly significant decrease of s/CRP and sal/CRP after periodontal treatment. Periodontitis is an occult infection that can be considered as a septic focus in SLE patients. CRP is a sensitive indicator for the presence of infection in SLE patients. Periodontal examination must be done routinely for all SLE patients