Background Periodontitis is an inflammatory disease affecting 70% of the adult population.Its most important consequence is the loss of bone supporting the teeth.Its medical treatment so far has not shown to be effective so only surgical techniques are useful in advanced stages.Osteoarthritis (OA) and periodontitis share physiopathological characteristics,as both present an important inflammatory component and bone structural modifications.Periodontitis could be a model for the study of OA,where tissue changes could be observed more directly.Chondroitin sulfate (CS) has shown a positive effect in chronic inflammatory diseases such as psoriasis,inflammatory bowel disease and OA.Thereby CS could be a safety and effective pharmacological therapy to this pathology,that currently has no specific treatment.
Objectives Demonstrate that an effective drug in OA pathology may improve both inflammatory symptoms and bone resorption occurred in periodontal disease,which would be reflected in changes in biochemical markers.
Methods Observational,prospective,pilot study in 26 patients diagnosed with knee OA and periodontitis.Patients were treated with CS 800mg/day (Condrosan®,Bioibérica SA) for 12 months. Löe and Silness gingival index (used to assess soft tissue damage) and CPITN (Community Periodontal Index of Treatment Needs) index were evaluated at 0, 3, 6, 9 and 12 months with saliva collection.Orthopantomographys were performed at 0,6 and 12 months to evaluate bone damage. Vertical lesions were measured at 0,6 and 12 months.Inflammatory (TNF-a,IL-1b,IL-18 and PGE2) and bone metabolism (OPG,OPN,RANKL and MMP-8) markers were quantified in the saliva by ELISA or protein array.Patients were asked to continue their usual oral hygiene without additional treatments.Statistical analysis was performed using Wilcoxon test for paired samples.
Results Löe and Silness index decreased significantly after 6,9 and 12 months of treatment (p=0.004, 0.007 and 0.002, respectively).In contrast,no significant changes were observed in CPITN values, probably due to the fact that only the most affected tooth is studied and it can differ between visits.Both orthopantomography as well as vertical lesions evolution, showed significant improvement at 12 months (p=0.009) and 6 and 12 months respectively (p=0.002 and p=0.016).For biochemical analysis results,patients with no gingival improvement were used as control group.The responders group to treatment shown a better performance for inflammatory markers PGE2, TNF-a and IL-1b,as well as bone metabolism markers, OPN, MMP -8,and the ratio OPG/RANKL.In responders groups,PGE2 levels showed a significant decreased after 12 months of treatment (p=0.033),whereas IL-1b levels in non responding patients suffered a significant increased after 3 and 6 months of treatment (p=0.017).
Conclusions CS improves soft tissue inflammation after 6 months of treatment and bone support at 12 months in periodontal disease,similar to the already known effect of the drug in OA disease.This improvement is reflected in markers of inflammation and bone metabolism in saliva.Due to its efficacy and safety profile,CS is postulated as a good candidate for the treatment of this disease.
Disclosure of Interest None declared