Abstract
Background:Recent data have renewed the interest in common pathobiologic pathways in autoimmune rheumatic conditions and periodontal disease, especially on dual impact of innovative anti-rheumatic drugs in modulating both inflammatory and immune articular as well as periodontal damage. Although consistent data about TNF inhibitors and chronic periodontitis are already published, the influence of IL-6 blockade.Objectives:We aimed to explore the influence of weekly subcutaneously IL-6 receptor inhibitor tocilizumab on periodontal health in a local cohort of patients with rheumatoid arthritis (RA) and chronic periodontitis (PD).Methods:We performed a prospective longitudinal 6 months study in 68 patients with moderate-to-severe RA starting tocilizumab (TCZ) in accordance to local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and dental (plaque index PI, gingival index GI, bleeding on probing BOP, pocket probing depth PPD, clinical attachment level CAL) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months.Results:51 RA and concomitant t of 68 patients in our initial cohort were finally analyzed. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serum C reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies ACPA). Furthermore, significant correlations between periodontal status, clinical disease activity and ACPA levels were also demonstrated (p<0.05). We also noticed consistent improvement was noticed in both RA-related parameters sand periodontal inflammation (GI and sites with bleeding of probing) after only 3 months (p < 0.05), while PPD improved after 6 months; overall, CAL presented only slight changes without statistical any significance as well as teeth count and plaque levels (p > 0.05).Conclusion:IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, essentially related to dramatic decrease in serum inflammatory mediators.
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