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

Smit, Menke J. de; Westra, Johanna; Posthumus, Marcel D.; Springer, G; Winkelhoff, A.J. van; Vissink, Arjan; Brouwer, Elisabeth; Bijl, Marc

doi:10.3390/ijerph18052529

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…Also, RA patients can have periods of disease remission/relapse and this way, the systemic inflammation will be altered increasing CRP levels 36 . The results agree with other studies 22,27,[37][38][39] , but systematic reviews have shown no effect of NSPT on ACPAs and RF, consequently, producing contrasting conclusions 23,40 . It has been suggested that NSPT has systemic effects by reducing periodontal inflammatory sources 21 .…”

Section: Discussionsupporting

confidence: 91%

Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study

et al. 2021

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Background: periodontal therapy has been suggested to have systemic effects. However, studies of periodontal therapy in rheumatoid arthritis patients have produced controversial results. Aim: To compare the effects of nonsurgical periodontal therapy on biochemical markers of rheumatoid arthritis and periodontal parameters in patients with and without rheumatoid arthritis. Methods: a prospective before-and-after study was conducted that included 21 participants without and 29 participants with rheumatoid arthritis. Periodontal parameters, Porphyromonas gingivalis detection, C-reactive protein, rheumatoid factor and anti-citrullinated protein antibodies were measured at baseline and three months after nonsurgical periodontal therapy and the changes were statistically assessed. Results: In general, both groups presented statistically significant improvement in periodontal parameters (p<0.05). There was an increase in the counts of P. gingivalis in both groups at three months. In addition, there was a reduction in levels of anti-citrullinated protein antibodies and rheumatoid factor in participants with rheumatoid arthritis. In contrast, C-reactive protein levels increased in both groups but were higher in the rheumatoid arthritis group. Periodontal parameters in rheumatoid arthritis participants under disease-modifying antirheumatic drugs presented a slightly higher improvement (p <0.05). Conclusions: Nonsurgical periodontal therapy has similar improvements in periodontal parameters in patients with and without rheumatoid arthritis. In addition, nonsurgical periodontal therapy may benefit serum levels of anti-citrullinated protein antibodies and rheumatoid factors in patients with rheumatoid arthritis. NCT04658615.

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Section: Discussionsupporting

confidence: 91%

Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study

et al. 2021

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“…This might be due to the limited access to biological treatment for many patients in Indonesia because of the high costs [ 33 ]. Antirheumatic treatment seems to have a negligible influence on the periodontal condition of RA patients, and to not have an influence on the subgingival presence of Pg and Aa, accordingly [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

No Obvious Role for Suspicious Oral Pathogens in Arthritis Development

Rahajoe

Smit

Raveling-Eelsing

et al. 2021

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A particular role for Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) has been suggested in periodontitis and rheumatoid arthritis (RA), as these bacteria could initiate the formation of rheumatoid factor (RF) and anticitrullinated protein autoantibodies (ACPA). We assessed whether serum antibodies against Pg and Aa in RA patients and non-RA controls reflect the subgingival presence of Pg and Aa, and evaluated the relationship of these antibodies to the severity of periodontal inflammation and RA-specific serum autoantibodies. In 70 Indonesian RA patients and 70 non-RA controls, the subgingival presence of Pg and Aa was assessed by bacterial 16S rRNA gene sequencing, and serum IgG levels specific for Pg and Aa were determined. In parallel, serum levels of ACPA (ACPA:IgG,IgA) and RF (RF:IgM,IgA) were measured. The extent of periodontal inflammation was assessed by the periodontal inflamed surface area. In both RA patients and the controls, the presence of subgingival Pg and Aa was comparable, anti-Pg and anti-Aa antibody levels were associated with the subgingival presence of Pg and Aa, and anti-Pg did not correlate with ACPA or RF levels. The subgingival Pg and Aa were not related to RA. No noteworthy correlation was detected between the antibodies against Pg and Aa, and RA-specific autoantibodies.

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“…On the other hand, another study has contradictory results and states that metotrexate and anti-TNF treatment has an insignificant effect on the periodontal status of RA subjects. [80].…”

Section: Dmardsmentioning

confidence: 99%

The Effect of Acknowledged and Novel Anti-Rheumatic Therapies on Periodontal Tissues—A Narrative Review

et al. 2021

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Rheumatoid arthritis (RA) and periodontal disease (PD) are chronic complex inflammatory diseases with several common susceptibility factors, especially genetic and environmental risk factors. Although both disorders involve a perturbation of the immune–inflammatory response at multiple levels, one major difference between the two is the different locations in which they develop. RA is triggered by an exaggerated autoimmune response that targets joints, while periodontal disease occurs as a consequence of the subgingival periodontopathogenic microbiota. Current treatment models in both pathologies involve the stratification of patients to allow therapeutic individualization according to disease stage, complexity, progression, lifestyle, risk factors, and additional systemic diseases. Therapeutic guidelines for RA comprise of five main classes of drugs: non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs): biologic and non-biologic. Although various treatment options are available, a definitive treatment remains elusive, therefore research is ongoing in this area. Several alternatives are currently being tested, such as matrix metalloproteinases (MMP) inhibitors, toll-like receptors (TLR) blockers, pro-resolution mediators, anti-hypoxia inducing factors, stem cell therapy, NLRP3 inhibitors and even natural derived compounds. Although the link between PD and rheumatoid arthritis has been investigated by multiple microbiology and immunology studies, the precise influence and causality is still debated in the literature. Furthermore, the immunomodulatory effect of anti-rheumatic drugs on the periodontium is still largely unknown. In this narrative review, we explore the mechanisms of interaction and the potential influence that anti-rheumatoid medication, including novel treatment options, has on periodontal tissues and whether periodontal health status and treatment can improve the prognosis of an RA patient.

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

Cited by 15 publications

References 30 publications

Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study

Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study

No Obvious Role for Suspicious Oral Pathogens in Arthritis Development

The Effect of Acknowledged and Novel Anti-Rheumatic Therapies on Periodontal Tissues—A Narrative Review

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