ANALYSIS OF ENDODONTIC TREATMENT OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Objective. To determine the clinical course and effectiveness of standard endodontic treatment for chronic apical periodontitis in patients with rheumatoid arthritis (RA). Materials and Methods.A total of 134 patients aged 29 to 67 years with chronic apical periodontitis were examined. Seventy-two patients with confirmed RA comprised the study group (Group I), and 62 patients without concomitant rheumatologic pathology comprised the control group (Group II). All participants were stratified into three age categories: 29–39 years, 40–54 years, and 55–67 years. Endodontic treatment followed a standardized protocol that included mechanical instrumentation with nickel-titanium (NiTi) rotary files, irrigation with 2.5 % sodium hypochlorite, placement of calcium hydroxide as an intracanal medicament, and obturation of root canals by warm vertical condensation of gutta-percha using an epoxy resin–based sealer. Treatment outcomes were evaluated clinically and radiographically at 6 and 12 months postoperatively. In Group I, indices of RA activity were additionally analyzed (DAS28 scoring). Results.At 6 months after treatment, complications were recorded in 18.1 % of Group I patients and 6.5 % of Group II patients. At 12 months, complication rates increased to 26.4 % in Group I and 9.7 % in Group II. The mean time to radiographic resolution of the periapical lesion in RA patients was 8.7 ± 2.1 months, which was significantly longer than in patients without RA (6.3 ± 1.6 months).Unfavorable outcomes were most frequently observed in men aged 55–67 years. In patients with high RA activity (DAS28 > 3.2), the complication rate reached 38.7 %.A significant positive correlation was found between RA activity and the incidence of treatment complications (r = 0.61; p < 0.01). Conclusions. These findings substantiate the need for interdisciplinary planning of endodontic interventions in RA patients. Management of chronic apical periodontitis should be tailored and performed during the phase of clinical–laboratory remission of the underlying rheumatologic disease.