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Association Between Dental Caries and Pneumonia in Patients with Systemic Lupus Erythematosus
VIRGINIA PASCUAL-RAMOS, CARLOS HERNÁNDEZ-HERNÁNDEZ, ARMANDO E. SOTO-ROJAS, ERIKA CELIS-AGUILAR, and JORGE SÁNCHEZ-GUERRERO ABSTRACT. Objective. To establish the association between oral pathology and pneumonia in patients with systemic lupus erythematosus (SLE). Methods. Thirty women with SLE, consecutively admitted for hospitalization because of pneumonia, and 60 noninfected controls with SLE (30 hospitalized and 30 ambulatory), matched by age, sex, and date of hospitalization to the cases, were enrolled. At entry, information about sociodemographic variables, traditional infection risk factors, SLE characteristics, treatment, and comorbidity was gathered by medical chart review. In every patient, one rheumatologist performed a complete physical examination, and assessed disease activity and chronic damage using validated indices; and one periodontist performed a standardized oral health evaluation including the use of 6 international oral health indices. Results. Twenty-eight patients with community-acquired and 2 patients with nosocomial pneumonias were included. Age of the total study population was 38.8 ± 14.6 years, mean number of SLE criteria 6.3 ± 1.95, and disease duration 6.6 ± 7.2 years, with no differences among the 3 groups. Cases had greater disease activity and damage, and were taking higher doses of prednisone than ambulatory controls (p ≤ 0.03). Cases accrued more traditional infection risk factors than ambulatory controls and had lower levels of serum albumin than both control groups (p ≤ 0.04). Oral health was worse among the cases, including more periapical lesions, cervical and third-grade caries, and a higher mean number of caries/patient than controls (p ≤ 0.05). In the multivariate analysis, third-grade caries (odds ratio 7.5, 95% CI 2.05–27.3, p = 0.002) was strongly associated with pneumonia. Conclusion. Poor oral hygiene and third-grade caries are common in patients with SLE who develop pneumonia. (First Release Sept 1 2006; J Rheumatol 2006;33:1996-2002) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS From the Department of Immunology and Rheumatology and the Dentistry Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. V. Pascual-Ramos, MD; C. Hernández, DDS; A.E. Soto-Rojas, MSc, DPH; E. Celis-Aguilar, MD; J. Sánchez-Guerrero, MD, MS, Department of Immunology and Rheumatology and Dentistry Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Address reprint requests to Dr. J. Sánchez-Guerrero, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000, Tlalpan, México, D.F., México. E-mail: jsanchez@quetzal.innsz.mx Accepted for publication May 13, 2006.
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