Rheumatoid arthritis risk in periodontitis patients: A systematic review and meta-analysis

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

“…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. Indeed, recent reviews and meta-analyses have already discussed periodontal disease in various RA settings (independent of age, disease duration, serology profile, and disease activity) compared to general population [ 1 , 3 , 5 , 11 , 19 , 20 , 21 , 23 ].…”

“…Recent meta-analyses reviewed the most important studies on TNF and non-TNF biologics in patients with RA and PD [ 5 , 20 ]. The critical difference between the class of TNF inhibitors and TCZ or B-cell depletive agent rituximab is that infliximab, an anti-TNF monoclonal antibody, may negatively address gingival inflammation although it may also improve alveolar bone destruction [ 5 , 6 , 7 , 19 , 37 ] resulting in a dissociated response for patients with severe periodontitis [ 5 ], while both tocilizumab and rituximab associate with significant a down regulation of gingival inflammation and damage in RA associated with periodontitis [ 16 , 17 , 27 , 28 , 50 ].…”

“…Periodontal disease (PD) is generally associated with a broad spectrum of chronic systemic disorders including diabetes, cardiovascular, respiratory, kidney, and neurodegenerative diseases as well as immune-mediated rheumatic conditions [ 1 , 2 , 3 , 4 , 5 , 19 ]. Several epidemiological studies have already communicated that PD is more prevalent during RA and vice versa [ 4 , 20 , 21 ]. Indeed, patients with PD have an increased risk to develop RA, compared to general population, particularly those with a long history of more severe periodontitis, mostly explained by excessive protein citrullination [ 14 , 21 ].…”

“…Indeed, patients with PD have an increased risk to develop RA, compared to general population, particularly those with a long history of more severe periodontitis, mostly explained by excessive protein citrullination [ 14 , 21 ]. Furthermore, it seems that P. gingivalis positive-periodontitis is more likely to occur in ACPA-positive individuals without any arthritis, suggesting that PD may precede RA [ 4 , 11 , 15 , 20 , 22 ]. On the other hand, RA patients experience a greater risk of PD, irrespective of disease duration, especially in ACPA-positive subtype [ 1 , 2 , 3 , 6 , 7 , 8 , 11 , 14 , 19 ]; moreover, they are prone to develop moderate to severe periodontitis in established compared to early disease [ 6 , 7 , 8 , 9 , 14 , 19 , 23 ].…”

Biosensor and Lab-on-a-chip Biomarker-identifying Technologies for Oral and Periodontal Diseases

“…Since periodontitis is a chronic inflammatory disease associated with microbial dysbiosis and host-driven tissue destruction (Atieh et al, 2014;Artese et al, 2015;Garde et al, 2019;Baeza et al, 2020) (Darre et al, 2008Engebretson and Kocher, 2013;Faggion Jr. et al, 2016;Ziukaite et al, 2018;Jain et al, 2019) Cardiovascular disease (Mustapha et al, 2007;Paraskevas et al, 2008;Freitas et al, 2012;Teeuw et al, 2014;Munz et al, 2018;Roca-Millan et al, 2018;Joshi et al, 2019;Munoz Aguilera et al, 2020) ( Bahekar et al, 2007;Blaizot et al, 2009;Almeida et al, 2018) Rheumatoid arthritis (Han and Reynolds, 2012;Kaur et al, 2014;Bender et al, 2017;Calderaro et al, 2017;Eskandari-Nasab et al, 2017;Hussain et al, 2020) ( Tang et al, 2017;Qiao et al, 2020) Obesity (Akram et al, 2016) (Papageorgiou et al, 2015) Irritable bowel disease * (Eskandari-Nasab et al, 2017;Papageorgiou et al, 2017;Lauritano et al, 2019;She et al, 2020) Osteoporosis (Kornman, 2008;Darveau, 2010), it is recognized that a single oral pathogen would not be sufficient to induce the most common forms of periodontitis. However, historically there were several studies focused on small subgroups of patients with rapidly progressing bone destruction occurring around certain teeth (molars and incisors), called localized aggressive periodontitis, whi...…”