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

Abstract

Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases that widely spread and share the same patterns of pro-inflammatory cytokines. This systematic review aims to evaluate the effects of non-surgical periodontal treatment (NSPT) on RA and, conversely, the impact of disease-modifying anti-rheumatic drugs (DMARDs) on periodontitis. PubMed, Embase, and Web of Science were searched using the MESH terms “periodontitis” and “rheumatoid arthritis” from January 2012 to September 2023. A total of 49 articles was included in the final analysis, 10 of which were randomized controlled trials. A total of 31 records concerns the effect of NSPT on parameters of RA disease activity, including a 28-joint disease activity score, anti-citrullinated protein antibodies, rheumatoid factor, C reactive protein, erythrocyte sedimentation rate, pro-inflammatory cytokines and acute phase proteins in serum, saliva, gingival crevicular fluid, and synovial fluid. A total of 18 articles investigated the effect of DMARDs on periodontal indexes and on specific cytokine levels. A quality assessment and risk-of-bias of the studies were also performed. Despite some conflicting results, there is evidence that RA patients and periodontitis patients benefit from NSPT and DMARDs, respectively. The limitations of the studies examined are the small samples and the short follow-up (usually 6 months). Further research is mandatory to evaluate if screening and treatment of periodontitis should be performed systematically in RA patients, and if the administration of DMARDs is useful in reducing the production of cytokines in the periodontium.

Clinical Efficacy of Extracellular Vesicle Therapy in Periodontitis: Reduced Inflammation and Enhanced Regeneration

“…This could help disrupt the pathogenic crosstalk between oral and systemic inflammation that contributes to the initiation and progression of associated comorbidities. Additionally, exosomes can also carry and deliver immunomodulatory cargo that could influence systemic inflammatory processes [ 84 , 85 ]. As such, applying EV therapy for periodontitis may have far-reaching impacts beyond just oral health by targeting shared inflammatory mechanisms underlying various systemic diseases.…”

Comorbidity of rheumatoid arthritis and periodontal diseases

“…по сравнению с группой пациентов, не получавших пародонтологического лечения. В испанском систематическом обзоре [117] показано, что консервативное лечение улучшает состояние пародонта у пациентов с пародонтитом и РА, оказывая положительное влияние на клинические и лабораторные параметры тестов (DAS28 и СОЭ) В итальянском систематическом обзоре [118] показано, что нехирургическое пародонтологическое лечение оказывает позитивное влияние на клинику РА, и, с другой стороны, влияние противоревматических препаратов, модифицирующих заболевание, благоприятно влияет на состояние пародонта.…”

Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

“…Cardiovascular diseases (CVDs) are the most frequent RA comorbidities [13,14]. Despite the increasing understanding of pathogenetic mechanisms, which involve various macrophage cytokines (specifically interleukins IL-1, IL-17, IL-6, IL-8, IL-4, IL-5, IL-10, IL-12, IL-13, IL-35, IL-21, IL-22, TNF-alfa, TGF-beta, INF-gamma, RANKL, and GM-CSF), antibodies released by B lymphocytes and the presence of T helper lymphocytes (CD4+), and their interaction with traditional cardiovascular risk factors, the optimal strategies for the risk assessment, prevention, and treatment of RA are still unclear [15][16][17][18][19][20][21][22] (Figure 1). The introduction of targeted biological and synthetic disease-modifying antirheumatic drugs (DMARDs) has improved clinical outcomes, reconfiguring the traditional cost composition of RA [23][24][25][26][27].…”