Abstract
Juvenile rheumatoid arthritis (JRA) - is a chronic systemic disease of connective tissue with joint disease, some patients with extra-articular manifestations, including in the maxillofacial area. The etiology of JRA is not known yet. In the pathogenesis is recognized the concept of the autoimmune process of an imbalance of immunocompetent cells as a result of neuro-immune-endocrine interactions. It is less well understood the effect of JRA on pathology teeth. The aim - studying hypophysis-adrenal regulation in patients with JRA with caries and enamel hypoplasia, depending on the intensity and duration of JRA. Materials and methods. We examined 65 patients with JRA (10-16 years) - the main group (MG), were divided into 4 groups: MG-1 - with caries and duration of JRA less than 6 years; MG-2 - with caries and enamel hypoplasia, with JRA less than 6 years; MG-3 - with caries, with JRA more than 6 years; MG-4 - with caries and enamel hypoplasia, with JRA more than 6 years. The comparison group (CG) - 15 healthy peers. The intensity of caries were studied. In oral liquor measured levels of cortisol and adrenocorticotropic hormone (ACTH). Results of studies and discussion. Patients with JRA cortisol content was significantly higher (8,03±4,94 ng/ml; p<0,001) and lower ACTH (10,42±6,15 pg/ml; p<0,001) in comparison with CG. Increasing of cortisol is regarded as appearance of protective adaptive response in under JRA and as signal of endogenous factor in the development of caries (suppression of Ca 2+ absorption in the intestine) and, possibly, activation of oligosaccharides - localfactor in the development of caries. In the MG-2 in comparison with CG revealed a significant changes of cortisol than the MG-1 (p<0,001). ACTH is reduced in comparison with the CG in the MG-1 (p<0,04) and MG-2 (p<0,03). In the MG-4 in comparison with children suffering from JRA less than 6 years, cortisol is reduced (p<0,02). In the MG-4 marked the most significant decrease in ACTH (p<0,02), which should be regarded as a violation of the reverse regulatory influence cortisol-producing function of adrenal on the functional activity of the pituitary gland. Conclusions. 1. Patients with JRA disease duration of more than 6years caries intensity is higher in comparison with children and adolescents suffering from less than 6years. 2. Intensity of caries in patients with JRA doen’t depend ofaffection tooth enamel hypoplasia. 3. In oral liquor ofpatients with JRA most elevated levels of cortisol and ACTH reduced when combined lesions of caries and enamel hypoplasia, regardless of the duration of JRA. 4. Growth of the intensity of caries with increasing duration of JRA due to a certain extent of the influence of systemic factors as a result of disturbances in the hypophysis-adrenocortical axis. 5. Caries in combination with enamel hypoplasia in patients with JRA is a clinical extra-articular manifestations, as well as predictive ofprogression of arthritis.
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