Rheumatoid arthritis serotype and synthetic disease-modifying anti-rheumatic drugs in patients with periodontitis: A case-control study

Abstract

Patients with rheumatoid arthritis (RA) experience a higher prevalence of periodontitis. This study aimed to examine the variation of periodontitis experienced with different serotypes suffered by RA patients and to examine the relationship between the different medications taken for RA that may influence this relationship. Two hundred and sixty RA and control participants underwent standardized periodontal examinations. Medical, serological and radiological (Sharp/van der Heijde) records were assessed. Functional status was assessed using the administered Health Assessment Questionnaire. Moreover, disease parameters, including disease activity (DAS28-ESR) and anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) seropositivity were evaluated. Periodontitis was higher in RA (71.54%) compared with controls (54.62%). The stage of periodontitis experienced by ACPA-positive participants were higher than APCA-negative participants. The probing pocket depth and recession experienced by RF-positive participants were higher than those who were RF-negative. RA participants on methotrexate had lower clinical attachment loss and lower periodontal probing depth compared with participants on a combination methotrexate and other disease-modifying antirheumatic drugs. Participants taking corticosteroids had lower gingival index scores. The association between seropositivity and the type of medications taken with periodontal health parameters in this group of patients suggests that both seropositivity and medications taken are important modifiers in the relationship between periodontitis and RA.

Periodontitis in rheumatoid arthritis

“…In animal models, oral inoculation of Porphyromonas gingivalis was found to exacerbate arthritis through the increased production of IL-17 25 . Therefore, periodontitis may also be important in the patients with already stablished rheumatic disease.…”

“…RA treatment may influence periodontitis; it has been described that the use of anti-IL-6 is associated with improvement in the gingival index, bleeding on probing, probing depth, and clinical attachment level 25 . Improvement in periodontal health with anti-TNF therapy and Jak inhibitors such as tofacitinib are also observed 32,33 .…”

The Effects of Periodontal Treatment on Rheumatoid Arthritis and of Anti-Rheumatic Drugs on Periodontitis: A Systematic Review

“…Nik-Azis N.M. et al compared two groups of patients with periodontitis, the first with RA and the second with osteoarthritis. They observed that MTX in monotherapy reduction in PD at 3 months, compared with MTX in combination with SSZ and HCQ [73].…”

The Effect of Periodontal Treatment on Clinical and Biological Indicators, Quality of Life, and Oral Health in Rheumatoid Arthritis Patients: A Quasi-Experimental Study

“…Another study concluded that citrulline levels in saliva are not associated with the severity of RA disease, despite significant differences in their periodontal status [17]. Other studies link these diseases since the treatment stage with specific medications for RA, as well as with the way in which these are associated with some periodontal health parameters, and how they can affect the periodontal health of this group of patients [18]. Moreover, they indicate that non-surgical periodontal therapy has a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition [19].…”