Avaliação comparativa do uso pré ou pós-operatório de amoxicilina em exodontias simples realizadas em pacientes portadores de artrite reumatoide tratados com inibidores de fator de necrose tumoral alfa e/ou metotrexato

Abstract

Rheumatoid arthritis (RA) is an autoimmune condition characterized by an inflammation of the joints. The medications most commonly used in the treatment of RA are disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) and biological agents such as tumor necrosis factor alpha inhibitors (anti-TNF-α). These drugs are immunosuppressive and they are related to a higher incidence of infections. The aim of this study was to evaluate the occurrence of inflammation, pain, scarring, and the presence of infections after tooth extraction in patients with RA treated with anti-TNF-α and MTX that used pre or postoperative amoxicillin. The RA patients were divided randomly into two groups: Group A (antibiotic prophylaxis – a single dose of amoxicillin 2g orally, 1h prior to the procedure) and group B (postoperatively antibiotic - 500mg of amoxicillin 8/8h for 5 days). In addition, a third group was created for control purposes that consisted of patients without RA and with no prescription of antibiotics. After evaluation of hematologic and radiographic parameters were performed 30 extractions (13 patients with RA and 12 in control group) by a single operator. The distribution of medications was made randomly and double-blind. Periodic evaluation (1,3,7,14 and 30 days after the procedure) were taken in order to identify clinical and radiographic signs of infection, inflammation. The evaluation of wound healing was done through measurement with a caliper at intervals of 24 hours, 72 hours, 7 days, and 14 days. A visual analogue scale (VAS) was used for verification of painful symptoms which was delivered to the patients after the extractions. All patients had 3 periapical radiographs (before extraction, with 24 hours and after 30 days) that were digitized and analyzed by ImageJ® software to verify radiographic healing period by modifying the alveolar radiolucent area. Most participants were women in control group (58.3%) and in groups A and B (83.3% and 100% respectively). Platelet levels of patients in groups A and B were higher than the control group (p = 0.008). In regard to inflammatory and infection signs, there was no significant difference between the three groups, as well as in pain levels and bone regeneration assessed radiographically, unlike tissue healing rates, where the groups A and B showed smaller areas of surgical wounds and the wounds contraction better than the control group (p = 0.005). Patients in groups A and B showed bone healing, inflammation and infection rate similar to the control group, however, the tissue healing parameters in groups A and B were higher when compared to the control group. In conclusion, it might be wise to suggest the use of amoxicillin prophylaxis considering rational antimicrobial use, since there was no difference between antibiotic regimens employed.