The relevance of the present study is due to the high prevalence of generalized periodontitis in patients with rheumatoid arthritis and the need to improve the effectiveness of its treatment, in particular by enhancing conservative therapy.
An experimental research to study the changes in periodontal tissues that occur in rheumatoid arthritis and the possibility of their correction using Quertgial and Imudon. The experiment was performed in 40 laboratory white eight-week-old male mice, with rheumatoid arthritis, simulated by immunization with bovine serum albumin and picryl chloride. As the result of experimental research there were identified accumulation of cellular infiltrates, microvascular damage, changes in a condition of connective tissue, emergence of mainly lymphocytic centers, increase in relative volume of plasma cells in 8,42 times and lymphocytes in 4.79 times were observed in microslides of the oral cavity mucous membranes as a systemic effect of rheumatoid arthritis.
Тhe proposed therapeutic approach improves the microcirculation (increase in relative vascular density of the microcirculatory tract by 1.6 times), reduces the relative volume of fibrous connective tissue by 1.5 times, reduces the cellular infiltrate by 4.21 times, normalizes qualitative ratio of cellular elements, which can be considered as remission of the rheumatic process in the oral cavity.
In order to increase the effectiveness of treatment of chronic generalized periodontitis in patients with rheumatoid arthritis, we proposed the use of Quertgial and Imudon as part of complex therapy of periodontal pathology.
To achieve the aim and objectives of the study, 80 patients with chronic generalized periodontitis of the II degree and concomitant rheumatoid arthritis aged 50 (9.28) years were selected for detailed clinical and laboratory examination. As part of the complex therapy, patients of group 1 received immunomodulator Imudon, group 2 – local treatment with mucoadhesive gel Quertgial, group 3 – a combination of these medications. Group 4 consisted of patients receiving traditional treatment for chronic generalized periodontitis. In order to prevent exacerbations of periodontitis. The papillary-marginal-alveolar index immediately after treatment decreased in group 3 by 53.12 (54.76 - 51.48) percent, while in group 4 the decrease reached 41.4 (43.85–38.94) percent (p <0,001). In six months after treatment, the values of the papillary-marginal-alveolar index decreased by 52.31 (54.45 - 50.18) and 35.42 (37.73 - 33.12), respectively (p <0.001). A significant decrease in the periodontal index immediately after treatment was registered in the group 3 – 2.20 (0.06) points, reaching statistically significant difference compared to all other groups (p <0.05). Six months after treatment, the growth rate of the index growth was the highest in the group with the traditional treatment regimen, and in the group with complex treatment – was not significant (p> 0.05). According to the results of ANOVA analysis of repeated measurements of oral elastase activity in the study groups, we established that the most successful, in terms of influence on this marker both in the immediate and long-term follow-up, were the groups with a comprehensive treatment regimen. The level of oral lysozyme after 20 days of treatment increased the most in group 3 (215.8% relative to baseline). Meanwhile, in the group with traditional treatment, the value increased by only 108.7%. Six months after treatment, the groups, where Imudon was used, did not differ significantly by the level of oral lysozyme (p> 0.05), and their values were the highest compared to other groups (p <0.001). The increase in the level of sIg A in oral fluid after 20 days of treatment in patients of group 3 reached 397.5% (p <0.001), while in the group with the traditional treatment, this value increased by only 77.2% (p <0.001). We detected significant advantages in six months after the treatment, compared to the initial level (p <0.001) with the highest values in the complex combined treatment group. Analysis of microbiological studies on the direct results of complex treatment showed decreased concentrations of Candida spp., S. sangius, Bacteroides fragilis, and E. coli significantly decreased by 92.1%, 93.0%, 44.4%, 100%, respectively (p <0.001), predominantly in the group of complex treatment with Imudon and Quertgial.
The results of our clinical trial allowed us to recommend the proposed complex treatment of chronic generalized periodontitis in patients with rheumatoid arthritis in combination with standard treatments for practical use.
The obtained research data allowed us to offer a prediction model of the long-term effect of treatment of chronic generalized periodontitis in patients with rheumatoid arthritis, protected by a patent of Ukraine for a utility model.
