The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial

Monsarrat, Paul; Grado, Gabriel Fernandez de; Constantin, Arnaud; Willmann, Claire; Nabet, Cathy; Sixou, Michel; Cantagrel, Alain; Barnetche, Thomas; Mehsen‐Cetre, Nadia; Schaeverbeke, Thierry; Arrivé, Élise; Vergnes, Jean-Noël

doi:10.1016/j.jbspin.2019.02.006

Cited by 42 publications

(41 citation statements)

References 36 publications

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“…Some previous studies suggested that the treatment of PD could improve RA outcomes [ 33 – 35 ]. However, the ESPERA randomized controlled trial [ 36 ] recently concluded that periodontal treatment led to periodontal health, but no significant effects on the DAS28-ESR [ 37 ]. At any rate, good dental hygiene is important for RA patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Another study 15 claimed that the fundamental pathogenic mechanisms of the two diseases are similar, although the cause of each disease may be different. Furthermore, a different study 16 reported positive effects of periodontitis treatment in the psychological aspect of RA patients, despite no improvement in their overall quality of life. On the contrary, a couple of other studies have reported that no associations were observed between RA and periodontitis.…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid arthritis and periodontitis in adults: Using the Korean National Health Insurance Service‒National Sample Cohort

Lee

Choi

2020

Journal of Periodontology

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Background Using the database of the National Health Insurance Service–National Sample Cohort (NHIS–NSC), we aimed to assess the relationship between the prevalence of rheumatoid arthritis (RA) and periodontitis. Methods Participants aged ≥19 years with a previous health check‐up at the NHIS between 2009 and 2015 were selected. In total, 559,280 participants were included after implementing appropriate exclusion criteria. The Chi‐squared test was used to compare the general and health‐related characteristics of participants with and without RA or periodontitis. Univariate and multivariate logistic regression analyses with consecutive adjustment for confounders, were used to assess the association between the prevalence of rheumatoid arthritis and periodontitis. Results The prevalence of rheumatoid arthritis in patients with and without periodontitis was 6.2% and 5.2%, respectively. The prevalence of periodontitis in patients with and without rheumatoid arthritis was 19.6% and 16.6%, respectively. The possibility of having rheumatoid arthritis was greater in patients with periodontitis than in individuals without periodontitis (odds ratio [OR]; 1.22, P <0.001), and remained high (OR; 1.07, P <0.001) after adjusting for confounders. Conclusion Our results revealed a significant association between the prevalence of rheumatoid arthritis and periodontitis.

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“…This procedure reduces the periodontal microbiota at least transiently is called a one-stage full mouth disinfection (FMD), which may be completed by short term systemic antibiotic therapy (150)(151)(152). In a recently published randomized controlled trial in patients with PD plus RA, no significant effect on RA disease activity was demonstrated upon standard PD therapy (153). However, although the autoantibody profile against citrullinated peptides remained unaffected, it was shown in another uncontrolled study that FMD plus antibiotics could be beneficial for RA in some highly selected patients (154).…”

Section: Effects Of Pd Treatment On Ramentioning

confidence: 99%

Infectious Triggers in Periodontitis and the Gut in Rheumatoid Arthritis (RA): A Complex Story About Association and Causality

et al. 2020

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Rheumatoid arthritis (RA) is a systemic immune mediated inflammatory disease of unknown origin, which is predominantly affecting the joints. Antibodies against citrullinated peptides are a rather specific immunological hallmark of this heterogeneous entity. Furthermore, certain sequences of the third hypervariable region of human leukocyte antigen (HLA)-DR class II major histocompatibility (MHC) molecules, the so called "shared epitope" sequences, appear to promote autoantibody positive types of RA. However, MHC-II molecule and other genetic associations with RA could not be linked to immune responses against specific citrullinated peptides, nor do genetic factors fully explain the origin of RA. Consequently, non-genetic factors must play an important role in the complex interaction of endogenous and exogenous disease factors. Tobacco smoking was the first environmental factor that was associated with onset and severity of RA. Notably, smoking is also an established risk factor for oral diseases. Furthermore, smoking is associated with extra-articular RA manifestations such as interstitial lung disease in anatomical proximity to the airway mucosa, but also with subcutaneous rheumatoid nodules. In the mouth, Porphyromonas gingivalis is a periodontal pathogen with unique citrullinating capacity of foreign microbial antigens as well as candidate RA autoantigens. Although the original hypothesis that this single pathogen is causative for RA remained unproven, epidemiological as well as experimental evidence linking periodontitis (PD) with RA is rapidly accumulating. Other periopathogens such as Aggregatibacter actinomycetemcomitans and Prevotella intermedia were also proposed to play a specific immunodominant role in context of RA. However, demonstration of T cell reactivity against citrullinated, MHC-II presented autoantigens from RA synovium coinciding with immunity against Prevotella copri (Pc.), a gut microbe attracted attention to another mucosal site, the intestine. Pc. was accumulated in the feces of clinically healthy subjects with citrulline directed immune responses and was correlated with RA onset. In conclusion, we retrieved more than one line of evidence for mucosal sites and different microbial taxa to be potentially involved in the development of RA. This review gives an overview of infectious agents and mucosal pathologies, and discusses the current evidence for causality between different exogenous or mucosal factors and systemic inflammation in RA.

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The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial

Cited by 42 publications

References 36 publications

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

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

Rheumatoid arthritis and periodontitis in adults: Using the Korean National Health Insurance Service‒National Sample Cohort

Infectious Triggers in Periodontitis and the Gut in Rheumatoid Arthritis (RA): A Complex Story About Association and Causality

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