Abstract
Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory diseases and periodontitis is known to be more common and more severe in patients with RA. Based on a paucity of studies about the relationship between common conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and periodontitis, this prospective study aimed to evaluate the adjunctive effect of csDMARDs on response to nonsurgical periodontal treatment in patients with RA. Thirty-two patients with RA (RA group) and 32 systemically healthy patients (control group) with periodontitis were included in this study. The RA group patients were treated with csDMARDs, such as methotrexate, hydroxychloroquine, and sulfasalazine. Conventional nonsurgical periodontal treatment with scaling and root planing was performed in both groups. The extent and severity of periodontitis were evaluated by plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) at baseline and 4 weeks after periodontal treatment. There was no statistically significant difference of periodontal parameters between the RA and control groups at baseline. Four weeks after scaling and root planing, PD reduction, and CAL gain were higher in the RA group treated with csDMARDs compared to the control group, and the difference was statistically significant (P = 0.006 and 0.003, respectively). A post hoc analysis of the RA group showed no statistically significant difference on the response to nonsurgical periodontal treatment in multiple csDMARDs therapy and addition of NSAIDs and/or steroids to csDMARDs. In patients with RA, csDMARDs showed beneficial effect on periodontal clinical parameters following the nonsurgical periodontal treatment.
Highlights
Rheumatoid arthritis (RA) is a chronic, systemic immunemediated inflammatory disease that may affect many tissues and organs, but primarily involves synovial joints [1]
As disease activity of RA is mostly assessed by determining the Disease Activity Score 28 (DAS28) including erythrocyte sedimentation rate (ESR) [12], inclusion criterion for the RA group was DAS 28-ESR > 3.2
Thirty-two patients diagnosed with RA, 6 men and 26 women ranging in age from 32 to 76 years (60.4±10.0 years), were assigned to the RA group
Summary
Rheumatoid arthritis (RA) is a chronic, systemic immunemediated inflammatory disease that may affect many tissues and organs, but primarily involves synovial joints [1]. Periodontitis is a chronic inflammatory process in which localized gingival inflammation due to bacteria destroys the alveolar bone and connective tissue that support the teeth [2]. In both diseases, the prevalence is low in young individuals and progressively increases with age [3,4,5]. The association between RA and periodontitis has long been studied and periodontitis is known to be more common and more severe in patients with RA [6,7,8] Both diseases have been suggested to share several pathogenic and pathologic characteristics [9, 10].
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