Abstract
Periodontitis, a bacterial-induced infection of the supporting soft and hard tissues of the teeth (the periodontium), is common in patients with rheumatoid arthritis (RA). As RA and periodontitis underlie common inflammatory pathways, targeting the progression of RA might mediate both periodontitis and RA. On the other hand, patients with RA on immunosuppressive medication have an increased risk of infection. Therefore, the objective of this longitudinal observation study was to assess the effect of methotrexate (MTX) and anti-tumor necrosis factor-α (anti-TNF, etanercept) treatment on the periodontal condition of RA patients. Overall, 14 dentate treatment-naive RA patients starting with MTX and 12 dentate RA patients starting with anti-TNF therapy in addition to MTX were included. Follow-up was scheduled matching the routine protocol for the respective treatments. Prior to the anti-rheumatic treatment with MTX or the anti-TNF therapy in addition to MTX, and during follow-up, i.e., 2 months for MTX, and 3 and 6 months for the anti-TNF therapy in addition to MTX, the periodontal inflamed surface area (PISA) was measured. The efficacy of the anti-rheumatic treatment was assessed by determining the change in RA disease activity (DAS28-ESR). Furthermore, the erythrocyte sedimentation rates were determined and the levels of C-reactive protein, IgM-rheumatoid factor, anti-cyclic citrullinated protein antibodies, and antibodies to the periodontal pathogen Porphyromonas gingivalis, were measured. Subgingival sampling and microbiological characterization of the subgingival microflora was done at baseline. MTX or anti-TNF treatment did not result in an improvement of the periodontal condition, while both treatments significantly improved DAS28 scores (both p < 0.01), and reduced C-reactive protein levels and erythrocyte sedimentation rates (both p < 0.05). It is concluded that anti-rheumatic treatment (MTX and anti-TNF) has negligible influence on the periodontal condition of RA patients.
Highlights
Periodontal disease is associated with a chronic inflammatory response due to a dysbiotic subgingival microbial ecology resulting in the destruction of the teeth-supporting soft and hard tissues [1]
Medicine and Rheumatology of the Martini Hospital Groningen, who were eligible for starting MTX treatment or MTX combined with anti-tumor necrosis factor-α (TNF) treatment, were included
I.e., before the MTX or MTX combined with anti-TNF treatment, and during the routine follow-up, rheumatoid arthritis (RA) disease activity (DAS28-erythrocyte sedimentationsedimentation rate (ESR)) was scored by two welltrained research nurses
Summary
Periodontal disease is associated with a chronic inflammatory response due to a dysbiotic subgingival microbial ecology resulting in the destruction of the teeth-supporting soft and hard tissues (periodontium) [1]. Aside from local tissue destruction, continuous low-grade inflammation may have systemic consequences. In this respect, a link between existence and/or severity of periodontal disease and systemic diseases, such as diabetes, cardiovascular disease, and rheumatoid arthritis (RA), has been shown [2,3].
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