Persistent Periodontal Disease Hampers Anti–Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis

Abstract

This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition.

Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case–Control Study

“…31,32 The human microbiome plays important roles in immune regulation and self-tolerance. 33 Disturbance of the intestinal microbiome has been linked to several autoimmune diseases, including IBD, 34,35 rheumatoid arthritis, [36][37][38][39][40] and at least 1 category of JIA. 14 After antibiotic treatment, commensal microbial populations often recover within ∼3 months, including in young children.…”

Periodontal Infections and Rheumatoid Arthritis

“…These fi ndings have been independently validated in populations from different geographic regions [ 38 -41 ]. In a more recent prospective study on RA patients initiating anti-TNF treatment, it was shown that the presence of persistent PD hampered the clinical response to TNFi, since only those patients without established PD achieved good RA outcomes [ 42 ].…”

Does Treatment of Periodontal Disease Influence Systemic Disease?

“…[108][109][110] The presence of periodontitis is also shown to hamper RA treatment with TNF-a blockers. 111 The periodontal bacterium P gingivalis is unique among the oral flora because it possesses an enzyme needed for protein citrullination, a major hallmark of RA. 109 Therefore, it would follow logically that reduction of the P gingivalis level and inflammation levels via periodontal treatment should decrease the severity of RA.…”