medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-079.medsovet-8250Research ArticleКОМОРБИДНЫЙ ПАЦИЕНТCOMORBID PATIENTКоморбидность ревматоидного артрита и заболеваний пародонтаComorbidity of rheumatoid arthritis and periodontal diseaseshttps://orcid.org/0000-0002-1597-1876ТруханД. И.TrukhanD. I.

Трухан Дмитрий Иванович, д.м.н., доцент, профессор кафедры поликлинической терапии и внутренних болезней

644043, Омск, ул. Ленина, д. 12

Dmitry I. Trukhan, Dr. Sci. (Med.), Associate Professor, Professor of the Chair of Polyclinic Therapy and Internal Disease

 12, Lenin St., Omsk, 644043

dmitry_trukhan@mail.ruСулимовА. Ф.SulimovA. F.

Сулимов Анатолий Филиппович, д.м.н., профессор, заведующий кафедрой челюстно-лицевой хирургии

644043, Омск, ул. Ленина, д. 12

Anatoliy F. Sulimov, Dr. Sci. (Med.), Professor, Head of the Department of Maxillofacial Surgery

 12, Lenin St., Omsk, 644043

afsulimov@yandex.ruТруханЛ. Ю.TrukhanL. Yu.

Трухан Лариса Юрьевна, к.м.н., врач-стоматолог

644043, Омск, ул. Ленина, д. 12

Larissa Yu. Trukhan, Cand. Sci. (Med.), Dentist

 12, Lenin St., Omsk, 644043

Омский государственный медицинский университетРоссияOmsk State Medical UniversityRussian Federation20241305202405288297Copyright © Трухан Д.И., Сулимов А.Ф., Трухан Л.Ю., 20242024Трухан Д.И., Сулимов А.Ф., Трухан Л.Ю.Trukhan D.I., Sulimov A.F., Trukhan L.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8250

Растущее количество доказательств свидетельствует о том, что патология пародонта, сопровождающаяся воспалением полости рта и патологическими изменениями в микробиоме полости рта, индуцирует изменение микробиома кишечника (ось «рот – кишечник»), участвует в патогенезе системных заболеваний. Настоящий обзор сосредоточен на опубликованной литературе, с акцентом на последнее десятилетие, в которой оценивается, являются ли болезни пародонта, прежде всего пародонтит, и пародонтопатические бактерии, факторами риска развития ревматоидного артрита. В рамках обзора рассмотрены двусторонние связи между ревматоидныи артритом и патологией пародонта, выделены основные звенья этой связи. Porphyromonas gingivalis и другие пародонтопатические бактерии могут способствовать развитию воспалительных заболеваний путем ремоделирования обычно доброкачественной кишечной микробиоты в дисбиотическую.

P. gingivalis экспрессирует эндогенные цитруллинированные белки и собственный уникальный бактериальный фермент пептидил-аргининдеминазу, что приводит к образованию аутоантител к циклическому цитруллинированному пептиду и нарушению иммунотолерантности у восприимчивых пациентов к ревматоидному артриту. Результаты клинических исследований показывают, что люди с пародонтитом и инфекцией P. gingivalis подвергаются риску развития ревматоидного артрита, что подтверждает результаты экспериментальных исследований. Нехирургическое пародонтологическое лечение, вероятно, эффективно в борьбе с ревматоидным артритом за счет снижения активности заболевания (в первую очередь DAS28 и СОЭ). Эти наблюдения свидетельствуют о важности здоровья пародонта и необходимости профилактики и раннего лечения пародонтита у больных ревматоидным артритом.

A growing body of evidence suggests that periodontal pathology, accompanied by oral inflammation and pathological changes in the oral microbiome, induces changes in the gut microbiome (oral-gut axis) and is involved in the pathogenesis of systemic diseases. This review focuses on the published literature, with an emphasis on the last decade, assessing whether periodontal disease, primarily periodontitis, and periodontopathic bacteria are risk factors for the development of rheumatoid arthritis. The review examines the bilateral connections between rheumatoid arthritis and periodontal pathology, and highlights the main links in this connection. Porphyromonas gingivalis and other periodontopathic bacteria may contribute to the development of inflammatory diseases by remodeling the normally benign gut microbiota into a dysbiotic one. Porphyromonas gingivalis expresses endogenous citrullinated proteins and its own unique bacterial enzyme, peptidyl arginine deminase, leading to the formation of cyclic citrullinated peptide autoantibodies and impaired immunotolerance in susceptible patients. to rheumatoid arthritis. Results from clinical studies suggest that people with periodontitis and Porphyromonas gingivalis infection are at risk of developing rheumatoid arthritis, supporting findings from experimental studies. Non-surgical periodontal treatment is likely effective in controlling rheumatoid arthritis by reducing disease activity (primarily DAS28 and ESR). These observations highlight the importance of periodontal health and the need for prevention and early treatment of periodontitis in patients with rheumatoid arthritis.

пародонтитпародонтопатические бактерииPorphyromonas gingivalisантитела к циклическому цитруллинированному пептидумикробиоценоз кишечникасиндром повышенной эпителиальной проницаемостиось «рот – кишечник»нехирургическое лечение пародонтитаperiodontitiscomorbidityperiodontopathic bacteriaPorphyromonas gingivalisantibodies to cyclic citrullinated peptideintestinal microbiomehyperepithelial permeability syndromemouth-gut axisnon-surgical treatment of periodontitisReferencesТрухан ДИ, Филимонов СН, Викторова ИА. Клиника, диагностика и принципы лечения основных ревматических болезней. СПб.: СпецЛит; 2023. 239 с. Режим доступа: https://www.elibrary.ru/mvzgbg.Трухан ДИ, Филимонов СН, Викторова ИА. Клиника, диагностика и принципы лечения основных ревматических болезней. СПб.: СпецЛит; 2023. 239 с. Режим доступа: https://www.elibrary.ru/mvzgbg.Насонов ЕЛ, Лила АМ, Каратеев ДЕ, Мазуров ВИ, Амирджанова ВН, Белов БС и др. Ревматоидный артрит: клинические рекомендации. М.; 2021. 112 с. 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The authors declare that there are no conflicts of interest present.