Is there an effect of anti-TNF-α drugs on Chronic Periodontitis in subjects with Rheumatoid Arthritis? A Scoping Review

Abstract

Chronic periodontitis (CP) is a multi-factorial disease affecting the periodontium, which destroys the alveolar bone and its supporting structures, eventually leading to tooth loss. Rheumatoid arthritis (RA), a chronic inflammatory disorder, affects the joints and causes their destruction, leading to disability. Although CP is essentially a microbial infection, it triggers the destructive host response that destroys the periodontal tissues and produces systemic consequences. Likewise, RA is an autoimmune disorder that causes bone resorption due to the release of inflammatory mediators, such as tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1β, which induce monocyte chemoattractant protein-1 (MCP-1) and lytic enzymes that promote osteoclast formation and phagocytosis. Lately, anti-TNF-α drugs have been studied for their cytokine-blocking ability. They bind to TNF-α and block its biological effects with marked improvement in clinical and laboratory inflammatory parameters. However, there is only minuscule information about their effects on CP. Purpose: This review evaluated the role of anti-TNF-α drugs on CP in subjects with RA. Methods: A systematic search of databases like Medline (Pubmed), Embase, Scopus, and Web of Science and manual search yielded 48 studies, of which 7 were selected based on the inclusion criteria. Results: It was observed that anti-TNF-α drugs significantly inhibited TNF-α activity in RA and produced a positive effect on the periodontal parameters. However, some studies concluded that there was no direct influence of anti-TNF-α drugs on CP parameters. Conclusion: Anti-TNF-α drugs may be a plausible modality for managing CP associated with RA. These agents may be helpful in CP owing to their anti-inflammatory effect. Moreover, improvement of RA, may indirectly enhance the manual dexterity required for maintaining oral hygiene in these patients with resultant improvement of periodontal health. However, more evidence supporting this is needed; hence, future clinical trials in humans are imperative.