Effects of different immunosuppressive drugs on the periodontal status and changes in periodontal pathogenic bacterial flora in rheumatoid arthritis patients

Abstract

Purpose: To investigate the prevalence of periodontal disease(s) and the associated bacteria among rheumatoid arthritis (RA) patients treated with different immunosuppressive drugs.Methods: Patients aged 18 – 65 years who had a 6-month history of RA, and were diagnosed as per the American College of Rheumatology and European League against Rheumatism, were included in the study. Supragingival plaque was removed by dentists. Using sterile paper strips, sub-gingival biofilm samples were collected from 5 of the deepest periodontal pockets. The samples were sent to pathologists for assessment. Polymerase chain reaction was carried out on them. Detection thresholds were >102 for Aggregatibacter actinomycetemcomitans, while the detection threshold for Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenellacorrodens, and Capnocytophaga species was 103.Results: There was a higher number of patients with bleeding-on-probing amongst cohorts who received a combination of methotrexate and tumor necrosis factor-α antagonist than in those given leflunomide only (52 vs. 29, p = 0.041, q = 3.064), or methotrexate + rituximab (52 vs. 30, p = 0.041, q = 3.131, Fig. 1). Papilla bleeding index was lowest in patients who were treated with leflunomide. Almost all patients had dental infection with Fusobacterium nucleatum.Conclusion: These results indicate that treatment of RA with methotrexate results in periodontal inflammation.

Impact of treatment of rheumatoid arthritis on periodontal disease: A review

“…Among the 35 included studies published until January 2023, 19 are cross‐sectional studies (Gamel et al., 2017; Hashimoto et al., 2021a, 2021b; Hatipoğlu et al., 2022; Jung et al., 2018; Kordtabar et al., 2019; Mayer et al., 2009, 2013; Mirrielees et al., 2010; Nik‐Azis et al., 2021; Ortiz et al., 2009; Pischon et al., 2008; Renvert et al., 2020; Romero‐Sanchez et al., 2017; Rovas et al., 2021; Schmalz et al., 2021; Wu et al., 2021; Yamashita et al., 2020; Ziebolz et al., 2018), 6 are case control studies (Äyräväinen et al., 2017, 2018a, 2018b; de Smit et al., 2021; Kobayashi et al., 2015; Kobayashi, Okada et al., 2014); 8 are longitudinal studies (Ancuta et al., 2017, 2020, 2021; Fabri et al., 2015; Kadkhoda et al., 2016; Kobayashi, Yokoyama et al., 2014; Savioli et al., 2012; Üstün et al., 2013), and 2 are cross‐sectional and longitudinal analyses in the one and the same article (Coat et al., 2015; Pers et al., 2008). All the studies were prospective except for one cross‐sectional study (Yamashita et al., 2020).…”

“…NSAIDs and corticosteroids were used (alone or in combination) as primary treatment for RA in two cross‐sectional studies (Wu et al., 2021; Ziebolz et al., 2018). The authors found no intergroup differences in periodontal clinical parameters in term of PD, CAL, BOP, or PI.…”

“…The authors found no intergroup differences in periodontal clinical parameters in term of PD, CAL, BOP, or PI. Combined NSAID and glucocorticoids were associated with the presence of Treponema denticola in dental plaque (Wu et al., 2021; Ziebolz et al., 2018).…”

Efficacy of etanercept in rheumatoid arthritis patients and its effects on interleukin 6 and serum tumor necrosis factor α

“…Most RA patients need lifelong treatment, since RA has a long treatment cycle [6]. At present, the common RA treatment drugs are non-steroidal antiinflammatory drugs, slow-acting anti-rheumatic drugs and steroids, although their effects are not durable, while some result in adverse side effects [7]. Thus, it is important to find active and effective RA treatment drugs with few side effects.…”

Short-term and long-term outcomes of zirconium dioxidebased dental restorations, and it effects on masticatory function

“…The number of oral diseases has been on the increase, and this is closely related to poor living environments and unhealthy dietary habits. Meanwhile, with continuous improvement in people's living standards and their aesthetic requirements, more and more people prefer to go to hospitals to improve their aesthetics through oral prosthetics [2]. In oral prosthetics, the popular metal-ceramic restorations have the advantages of wear resistance, corrosion resistance, and high biocompatibility.…”