Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis

Rosa, Cléber Davi Del Rei Daltro; Gomes, Jéssica Marcela de Luna; Moraes, Sandra Lúcia Dantas de; Lemos, Cleidiel Aparecido Araújo; Minatel, L; Limírio, João Pedro Justino de Oliveira; Pellizzer, Eduardo Piza

doi:10.1016/j.sdentj.2021.09.007

Cited by 6 publications

(14 citation statements)

References 34 publications

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“…Three studies were SRs without meta-analysis 23,35,36 and six were SRs with meta-analyses [19][20][21][22]24,25 . The studies were developed in Brazil 21,22 , China 20,25 , Australia 24,36 , United Kingdom 35 , Portugal 19 , and Spain 23 and were published between 2011 and 2022. Most of the included studies were published in English [19][20][21]23,24,35,36 , but there were also publications in Portuguese 22 and Chinese 25 .…”

Section: Characteristics Of the Srsmentioning

confidence: 99%

“…Regarding quality analysis/risk of bias assessment, one study 23 did not perform any evaluation. The other studies used different tools, such as Cochrane [19][20][21]25,35 , Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) 35 , the Newcastle-Ottawa scale (NOS) 21 , PEDro 22 , and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) 24,36 .…”

Section: Characteristics Of the Srsmentioning

confidence: 99%

“…Of these, six articles 19,20,22,23,24,35 had titles/abstracts that satis ed the eligibility criteria and were included. The title/abstracts of 10 articles contained insu cient information for a decision and full texts were evaluated considering the eligibility criteria; seven articles were excluded for different reasons (Supplementary le 3) and three 21,25,36 were included. No references that met the eligibility criteria were found in searches in the reference list of included articles or in the searches in grey literature.…”

Section: Study Selectionmentioning

confidence: 99%

“…Management of periodontitis aims to dismantle the related bacterial bio lm and involves non-surgical periodontal treatment (NSPT) with scaling and root planning, along with oral hygiene education 17,18 . Although previous Systematic Reviews (SRs) revealed that RA outcomes, particularly disease activity, can improve with NSPT [19][20][21][22] , the results of some SRs [23][24][25] and recent individual study 26 failed to con rm that. Given this controversial scenario and to build more robust evidence on the effect of NSPT in RA outcomes, we performed an overview and a meta-analysis pooling data from all primary studies identi ed through the included SRs.…”

Section: Introductionmentioning

confidence: 99%

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Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

Oliveira,

Arruda,

Schneider

et al. 2023

Preprint

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To perform an overview by analyzing clinical outcomes in individuals with rheumatoid arthritis (RA) who underwent non-surgical periodontal treatment (NSPT). Electronic searches were conducted across four databases and gray literature with no restriction on language or publication date. The study followed the 2020 PRISMA statement. A meta-analysis was performed comprising 18 primary studies from SRs to examine the effects of NSPT (n = 201 subjects in the non-NSPT vs. n = 199 in the NSPT group) on 28-joint Disease Activity Score (DAS28). Nine SRs were analyzed; of these, six with meta-analyses and three without meta-analyses. The main outcomes evaluated were DAS28, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). NSPT resulted in a significant decrease in CRP, ESR and DAS28, both in studies that included a control group (without NSPT) or in those comparing individuals before and after periodontal therapy. Follow-up period after NSPT ranged from 6 to 24 weeks. Despite the heterogeneity of data related to RA and periodontitis status and antirheumatic therapy, NSPT was able to reduce the levels of systemic inflammatory markers and RA activity.

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Section: Characteristics Of the Srsmentioning

confidence: 99%

Section: Characteristics Of the Srsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

Oliveira,

Arruda,

Schneider

et al. 2023

Preprint

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“…There is consistent evidence that PD is associated with higher RA disease activity, whereas RA disease activity does not have an effect on severity of PD [ 6 ]. The bidirectional association between RA and PD can also be found in the effect of treatment of one condition on the other [ 7 , 8 ]. A review of literature concerning cytokines in the local inflammatory exudate of the periodontium (gingival crevicular fluid, GCF) of patients with RA revealed also a bidirectional relationship between RA and PD, probably caused by a non-specific inflammatory burden [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of Oral Microbiota on the Presence of IgA Anti-Citrullinated Protein Antibodies in Gingival Crevicular Fluid

Smit

Rahajoe

Raveling-Eelsing

et al. 2022

Front. Oral. Health

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IntroductionThe relation between rheumatoid arthritis (RA) and periodontitis (PD) has been investigated ever since the discovery of the citrullinating enzyme peptidyl arginine deaminase presents in the oral bacterium Porphyromonas gingivalis. Recently, we demonstrated the presence of RA autoantibodies, especially of IgA anti-citrullinated protein antibody (ACPA), in gingival crevicular fluid (GCF) of Indonesian patients with and without RA or PD which might indicate the local formation of RA antibodies in the periodontium.AimThe purpose of this study was to assess whether the subgingival microbiome is related to the presence of IgA ACPA in the GCF of healthy individuals with or without PD.Patients and MethodsHealthy individuals with a known periodontal status and high IgA ACPA (>0.1 U/ml) in GCF (n = 27) were selected and matched for age, gender, periodontal status, and smoking status with 27 healthy individuals without IgA ACPA in their GCF. Taxonomic profiling of the subgingival microbiome was based on bacterial 16S rRNA gene sequencing. Downstream analyses were performed to assess compositional differences between healthy subjects with or without IgA ACPA in GCF and with or without PD.ResultsBetween groups with or without PD, or with or without IgA ACPA in GCF, no differences in alpha diversity were seen. Beta diversity was different between groups with or without PD (p < 0.0001), and a trend was seen in subjects with PD between subjects with or without IgA ACPA in GCF (p = 0.084). Linear discriminant analysis effect size (LEfSe) revealed no significant differences in the total population between subjects with IgA ACPA compared to subjects without IgA ACPA in GCF. Although Porphyromonas was not identified by LEfSe, its relative abundance was significantly higher in healthy individuals with high IgA ACPA in GCF compared to individuals without IgA ACPA in GCF (p = 0.0363). Zooming in on the subgroup with PD, LEfSe revealed that species Neisseriaceae, Tannerella, and Haemophilus were more abundant in the subjects with IgA ACPA in GCF compared to subjects without IgA ACPA in GCF.ConclusionPeriodontitis and certain taxa, including Porphyromonas, seem to be associated with the local presence of ACPA in the periodontium.

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Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review

Mustufvi

Twigg

Kerry

et al. 2022

Rheumatology Advances in Practice

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OBJECTIVES The association of periodontal disease in people diagnosed with rheumatoid arthritis (RA) is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease may benefit people with RA. We performed a systematic literature review (SLR) to investigate the effect of periodontal treatment on RA disease activity. METHODS Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. Quality assessment of included studies was performed and data were grouped and analysed according to RA disease outcome measure and a narrative synthesis performed. RESULTS We identified a total of 21 studies of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA Disease activity score (DAS-28) was the primary outcome for most studies. A total of 9/17 studies reported a significant intra-group DAS-28 score change. Three studies demonstrated a significant intra-group improvement in ACPA level following NSPT. Other RA biomarkers showed high levels of variability at baseline and following periodontal treatment. CONCLUSION There is some evidence to suggest periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer follow up durations are needed. The selection of the study population, periodontal interventions, biomarker, and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with pre-specified disease characteristics. Lay summary What does this mean for patients? This review found 21 research trials which investigated the effect of gum disease treatment on rheumatoid arthritis. The key finding was that treating gum disease in people who have rheumatoid arthritis improves the ‘DAS28’ score, which is a measure of how severe the rheumatoid arthritis is. This is important, as rheumatoid arthritis is incurable and has a significant impact on quality of life. Furthermore, gum disease is more prevalent in people with rheumatoid arthritis, and if untreated can lead to pain, infection, and premature tooth loss. This review highlighted several limitations of the included trials. In addressing these limitations, the review makes important recommendations for future research on this topic to ensure further high-quality findings. Finally, this review makes a strong case that rheumatologists, dentists and people who are affected by rheumatoid arthritis should have a heightened awareness of the link between these two diseases. Screening and treating gum disease should form part of the normal care pathway for people with rheumatoid arthritis.

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Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis

Cited by 6 publications

References 34 publications

Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

Influence of Oral Microbiota on the Presence of IgA Anti-Citrullinated Protein Antibodies in Gingival Crevicular Fluid

Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review

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