Efficacy of baricitinib on periodontal inflammation in patients with rheumatoid arthritis

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

“…We also focused on the magnitude of compromised oral health in RA; most patients in our initial group presented a high rate of mild and severe periodontal disease, validating/reinforcing the already known risk of periodontitis in such patients, particularly in established, longstanding disease [2][3][4]9,37]. We have included in the final analysis only those cases with overt periodontal disease, meaning that up to 75% had at baseline altered periodontal status in a group of consecutive patients starting TCZ for their active disease.…”

“…The evolving model for dynamic interrelation between RA and PD encourages the concept that standard management for RA may be effective in improving the outcomes in PD and vice versa [4,7,14,19,[37][38][39]. 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].…”

“…The evolving model for dynamic interrelation between RA and PD encourages the concept that standard management for RA may be effective in improving the outcomes in PD and vice versa [4,7,14,19,[37][38][39]. 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].…”

“…However, there are differences among anti-TNF agents as only adalimumab and etanercept significantly improved periodontal outcomes in as rapid as six months, while infliximab worsened gingival inflammation but prevented gingival bone loss [5,14]. Furthermore, according to a study by Kobayashi and colleagues, tocilizumab (TCZ) also ameliorates periodontal inflammation in RA with periodontitis as TNF inhibitors do [16,17,27,28,31,32,36,37]. Its beneficial effects were potentially explained by the decrease in TNF-α serum levels as well as immunoglobulin G and serum amyloid along with a consistent impact on serum inflammatory mediators and indirect influence on periodontal inflammation [16,17,27,28,40].…”

“…On the other hand, several papers have addressed the effect of specific periodontal therapies (e.g., non-surgical scaling and root planning) on clinical RA activity in patients with chronic periodontitis with controversial results [37,[51][52][53][54][55][56][57]. The most recent data from the ESPERA (Experimental Study of Periodontitis and Rheumatoid Arthritis) cohort failed to demonstrate clinical improvement in established RA following aggressive and intensive periodontal treatment [57].…”