Association of Periodontitis with Rheumatoid Arthritis and the Effect of Non-Surgical Periodontal Treatment on Disease Activity in Patients with Rheumatoid Arthritis

Abstract

BackgroundThe association of periodontitis (PD) with the prevalence of rheumatoid arthritis (RA) remains controversial. Therefore, the aim of this study was to evaluate their correlation and investigate the effects of non-surgical periodontal treatment on RA.Material/MethodsA total of 64 patients were enrolled in this study and divided into 4 groups: 18 PD patients (PD+RA−), 18 RA patients (PD−RA+), 18 RA with PD patients (PD+RA+), and 10 healthy controls (PD−RA−). Periodontal and rheumatologic parameters were examined at baseline and 1 month following non-surgical periodontal treatment.ResultsOur results showed that RA patients had similar periodontal status. However, patients in the PD+RA+ group had significantly higher levels of rheumatologic parameters such as C-reactive protein (CRP), anti-cyclic citrulline peptide antibody (ACPA), erythrocyte sedimentation rate (ESR), and Disease Activity Score 28 (DAS28) than those in the PD−RA+ group. In addition, non-surgical periodontal treatment was efficacious in improving rheumatologic parameters of patients in the PD+RA+ group.ConclusionsThe presence of PD might contribute to the progression of RA, while RA might have little effect on accelerating the development of PD. In addition, RA patients with PD receiving non-surgical periodontal treatment resulted in noteworthy improvement in the clinical outcome for RA.

Salivary and serum cathelicidin LL‐37 levels in subjects with rheumatoid arthritis and chronic periodontitis

“…In the RA-CP group, positive correlation was observed between periodontal parameters (GBI, PISA) and the rheumatology data ESR, while CAL and PPD were also positively correlated with 37,38 We observed in this study that females showed higher levels of LL-37 in both serum and saliva in the healthy group. This finding has also been reported in studies investigating the levels of LL-37 in plasma and urine samples of patients with urinary tract infection.…”

“…presence of RA was not shown to worsen the severity of CP. 36,37 However, both studies mentioned that the presence of periodontitis was associated with RA disease progression. The subjects in Scher et al (2012) who showed that RA presented with worse CP conditions were newly diagnosed RA subjects without any treatment, 6 whereas the subjects in our study had been undergoing RA treatment for an average of 5-6 years.…”

Neutrophil Extracellular Traps in Periodontitis

“…Evidence has suggested that citrullinated antigens in RA are mostly derived from NETs [98]. Patients with periodontitis may have RA and vice versa [99]. A recent publication has suggested that periodontal indices such as gingival index, probing pocket depth (PPD) and bleeding on probing (BOP) have positive relationships with RA.…”

Gums and joints: is there a connection? Part one: epidemiological and clinical links

“…35 Since then, three studies have been published, all of them reporting a significant improvement of RA parameters after periodontal therapy. [36][37][38] Although these results are promising, some authors have failed to observe this effect. In a case report of one RA patient undergoing periodontal treatment for 15 years, no beneficial effect was reported.…”