Periodontal disease and influence of periodontal treatment on disease activity in patients with rheumatoid arthritis and spondyloarthritis

Abstract

The aim of this study was to assess the prevalence of periodontal disease and the effect of periodontal treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Forty-four RA patients, thirty SpA patients and thirty-nine healthy volunteers were recruited to the study. Periodontal examination included the approximal plaque index (API), bleeding on probing (BoP), probing depth (PD) and number of teeth. Samples from the deepest periodontal pockets were taken for the detection of Porphyromonas gingivalis DNA with the use of the polymerase chain reaction. All subjects with periodontitis, who completed the study, received periodontal treatment consisting of scaling/root planing and oral hygiene instructions. Disease activity scores, clinical and laboratory parameters were assessed before and 4-6 weeks after periodontal treatment. No significant difference in the prevalence of periodontal disease and the presence of P. gingivalis DNA were found in RA and SpA patients compared to healthy controls. Significantly higher API (80% vs 63%; p = 0.01) and a lower number of teeth (20 vs 25, p = 0.001) were found in RA patients. BoP was significantly elevated in SpA patients (51% vs 33%, p = 0.02). Disease activity measured by the DAS28(CRP) was significantly reduced in RA patients after periodontal treatment (p = 0.002). Clinical and biochemical parameters were not improved in SpA patients. Nonsurgical periodontal treatment had an impact on the decrease in RA activity. Periodontal examination is necessary in patients with RA to detect and treat periodontitis at an early stage.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Periodontitis and rheumatoid arthritis: What have we learned about their connection and their treatment?

“…Nevertheless, the randomized controlled trials selected in both systematic reviews represented a short follow‐up period (of less than 6 months) and a small sample size, thereby making interpretation of the data difficult. Even although some of these interventional studies have shown a decrease in rheumatoid arthritis disease activity after periodontal therapy, 134‐140 there are also studies not reporting any impact 141‐143 . Similarly, in a 3‐month randomized clinical trial, Monsarrat et al 142 could not demonstrate a statistically significant reduction in 28‐joint disease activity score with erythrocyte sedimentation rate, although this study had a very short follow‐up, and unspecified periodontitis case selection and rheumatoid arthritis disease activity score criteria.…”

Neutrophil Extracellular Traps in Periodontitis

“…In addition, a high level of anti-P. gingivalis antibody could be regarded as a warning sign in RA patients suffering from periodontitis [101]. Non-surgical periodontal treatment has shown to improve symptoms in both diseases [102][103][104]. Previous studies demonstrated that NETs were increased in the synovial fluid, rheumatoid nodules, peripheral blood and skin of RA patients [92].…”

Serum anti-CCP antibodies in periodontitis associated with rheumatoid arthritis - relative value for the severity of periodontitis

“…Unlike the human enzyme, the bacterial enzyme deiminates both free arginine and C-terminal arginine residues. The different mechanisms of citrullination probably underlie the breakdown of immune tolerance and the development of an immune response to endogenous citrullinated peptides in susceptible individuals, through the generation of new epitopes [20].…”