Periodontite e o aumento do risco cardiovascular na artrite reumatoide: uma revisão sistemática e metanálise

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease that can cause irreversible joint damage and is associated with several comorbidities, with cardiovascular disease (CVD) being the leading cause of mortality in these patients. Periodontitis (PD), a chronic inflammation of the tooth-supporting tissues, may influence systemic levels of inflammatory markers and pose a potential risk for both CVD and RA. This study aimed to evaluate, through a systematic review and meta-analysis, whether PD increases the risk of CVD in patients with RA [PROSPERO (CRD42024552063)]. The following databases were searched: MEDLINE via PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, LILACS via BVS, SCIELO, and LIVIVO. For grey literature, ProQuest Dissertation and Theses Global (PQDT Global) was used. Google Scholar was also consulted. A total of 1,732 studies were identified, of which 6 full-text articles were assessed, and 3 were included in the final analysis. The first study showed a higher risk of ischemic heart disease in patients with both RA and PD, influenced by age and RA duration. The second study highlighted an association between Anti-Aa (Aggregatibacter actinomycetemcomitans serotype b) and Anti-LtxA (Aa leukotoxin A) antibodies and atherosclerosis in RA. The third study identified an amplification of CVD -related biomarkers in patients with both RA and PD. The results indicated no significant association between PD and increased risk of CVD in RA patients. The limited number of eligible studies with methodological criteria compatible with the PECO question restricts the strength of the conclusions but underscores the need for well-designed, longitudinal studies with greater standardization to clarify this potential clinical interrelationship.