Objective To assess the effect and safety of periodontal therapy in relieving the symptoms and clinical rnsigns of rheumatoid arthritis (RA). Methods The electronic search was conducted in Medline(OVID, 1950-2010 Sep),rnEMBASE(1984-2010 Sep), CENTRAL(2010, Issue 3), CBM(1978-2010 Sep) and the Chinese journals on stomatornlogy were hand-searched. Clinical randomized controlled trials as well as clinical controlled trials were selected regarrnding the targeted issue. Two investigators evaluated the reporting quality and risk of bias of those included trials in acrncordance with CONSORT statement and Cochrane risk of bias assessment tools, and collected data of included studies rnin duplicate. Revman 5.0.23 was applied for Meta-analysis. Results Four trials met the inclusion criteria and a torntal of 150 patients were enrolled in the trials, one had low risk of bias and others had moderate risk of bias. Metarnanalysis showed that pure periodontal therapy could not decrease disease activity score in 28 joints (DAS28)(P=0.06),rnand there was no statistically significant difference between periodontal therapy with anti-tumor necrosis factor-α(TNF-rnα) medication and pure anti-TNF-α medication(P=0.24). But the subgroup analysis showed that a significantly derncreased DAS28 was achieved by periodontal therapy (P=0.03), and the interventions provided a remarkable effect on rnalleviating clinical signs and erythrocyte sedimentation rate of RA (p＜0.05). Results of the symptoms relief differed from rnthe studies. No adverse events were reported. Conclusion The evidence available currently indicates that periodontal rntherapy may play a positive role in remitting the clinical signs and periodontal status of RA except the relief of the rnsymptoms.%目的 评价牙周治疗措施在缓解类风湿性关节炎(RA)患者症状和体征中的效果及安全性.方法 电子检索Medline(OVID,1950年-2010年9月)、荷兰医学文摘(EMBASE,1984年-2010年9月)、Cochrane图书馆临床随机对照试验库(CENTRAL,2010年第3期)、中国生物医学文献数据库(1978年-2010年9月),手检相应中文口腔期刊,收集牙周治疗措施缓解RA患者症状和体征的临床随机对照试验和临床对照试验.2位研究者独立按照Cochrane临床研究方法学质量评价标准和CONSORT质量评价标准对文献进行偏倚风险和报告质量评价并提取数据.采用Revman 5.0.23进行Meta分析.结果 最终纳入文献4篇,涉及患者150名,其中1篇为低度偏倚风险文献,余均为中度偏倚风险文献.Meta分析显示,单纯牙周治疗并不能明显降低RA患者的28个关节的疾病活动度评分(DAS28)(P=0.06),牙周治疗联合抗肿瘤坏死因子-α(TNF-α)治疗与单纯抗TNF-α治疗相比差异无统计学意义(P=0.24),但对亚组合并分析显示牙周治疗能够明显降低DAS28水平CP=0.03).同时,牙周治疗在缓解RA患者的临床体征、红细胞沉降率和牙周状况方面疗效明显(P<0.05),但各研究对牙周治疗缓解RA患者症状的结论不尽相同.所有研究均未报道不良事件.结论 牙周治疗在缓解RA患者的体征和牙周状况方面可能具有积极作用,但对于症状的缓解尚无定论.
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