Does periodontitis affect the treatment response of biologics in the treatment of rheumatoid arthritis?

Abstract

Background: Rheumatoid arthritis (RA) and periodontitis (PD) have been suggested to share many clinical and pathological features. However, few reports have investigated the relationship between the degree of PD and the treatment response to RA. This study aimed to examine the relationship between the extent of PD and the treatment response to biologics in RA patients using FDG-PET/CT. Methods: Sixty RA patients (male, n = 14; female, n = 46; average age, 58.3 years) treated with biologic agents were included in this study. FDG-PET/CT was performed at baseline and 6 months after the initiation of biological therapy. The maximum standardized uptake value (SUVmax) was used as a representative value for the assessment of the FDG uptake in periodontal tissue and joints including the bilateral shoulders, elbows, wrists, hip, knees, and ankle joints. The Disease Activity Score (DAS) 28-CRP and the following clinical parameters were assessed: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated peptide antibody (ACPA), rheumatoid factor (RF), and matrix metalloproteinase 3 (MMP-3). The relationship between the treatment response of RA and the baseline SUVmax of the periodontal tissue was evaluated. Results: The baseline periodontal SUVmax was related to patient age (r = 0.302, p = 0.009) and the ACPA level (r = 0.265, p = 0.025). The DAS28-CRP, CRP, ESR, MMP-3, and joint SUVmax values were significantly decreased after 6 months of biological therapy. However, the mean periodontal SUVmax, ACPA, and RF showed no significant changes after treatment. There was a significantly negative correlation between the baseline periodontal SUVmax and the treatment response of DAS28-CRP (r = − 0.369, p = 0.004). Conclusion: There was a negative correlation between the extent of PD at baseline and the treatment response of RA patients who received biological therapy. The evaluation of the periodontal condition is considered to be an essential part for the management of RA.

Exploring the Role of Interleukin-6 Receptor Inhibitor Tocilizumab in Patients with Active Rheumatoid Arthritis and Periodontal Disease

“…We identified excessive gingival involvement confirmed by an increased percentage of sites with plaques and inflammation and abnormal periodontal status (e.g., increased probing depth, clinical attachment loss) supporting data from the literature [6,16,17,20,21,27,28,38,39,44,48]. Moreover, we recognized positive correlations between the severity of periodontitis, inflammatory parameters (especially CRP), serology (ACPA status and titers), and RA activity; indeed, recent studies suggest a worse periodontal status in active untreated RA, and higher CRP if RA is associated with severe periodontitis [6,11,[15][16][17]19,27,28,37].…”

“…Pivotal studies have already explored the role of different synthetic and biological therapies in active RA and comorbid periodontal disease, showing controversial results [ 5 , 9 , 12 , 16 , 17 , 25 , 28 , 35 , 36 , 37 , 38 , 39 ]. Overall, there is a trend to consider that TNF inhibitors, IL-6 receptor antagonist, B-cells depletive agents and, even, JAK inhibitors improve periodontal health in both RA and other arthritis (e.g., ankylosing spondylitis, psoriatic arthritis); it seems that all these drugs are ultimately effective in decreasing gingival and periodontal inflammation and, to a lesser extent, associated tissue damage [ 16 , 27 , 28 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Researchers even proposed a multistep approach of the sequential tissue repairing following TNF inhibitors, comprising reduced leukocytes traffic in the inflamed tissue, decreased proteolytic activity, and the normalization of osteoclast activity [ 1 , 5 , 9 , 12 ].…”

The Effect of Periodontal Treatment on Clinical and Biological Indicators, Quality of Life, and Oral Health in Rheumatoid Arthritis Patients: A Quasi-Experimental Study

“…This result appears to be biologically plausible as regards the periodontal treatment that is carried out in routine dental care and that concurs with periodontitis natural development. These results are similar to those obtained by other clinical studies [49,50].…”

Effect of Anti-Rheumatic Treatment on the Periodontal Condition of Rheumatoid Arthritis Patients

“…In both diseases, local tissue destruction involves the production of inflammatory cytokines and proteolytic proteins, such as matrix metalloproteinases. The presence of shared underlying inflammatory pathogenesis mediating the progression of both periodontitis and RA could provide potentially common therapeutic targets [ 8 ]. Traditional approaches to control RA rely on conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDS), such as methotrexate (MTX).…”