Abstract
Background: The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). Methods: We performed a 6-month prospective study in 51 patients with chronic periodontitis and moderate-to-severe RA starting TCZ in accordance with local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and periodontal (visible plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months. Results: We demonstrated significant correlations between periodontal status, disease activity, and serologic biomarkers (p < 0.05). Tocilizumab significantly improved the gingival index scores and decreased the number of sites with bleeding on probing after only 3 months (p < 0.05), while the probing pocket depth significantly decreased after 6 months; overall, clinical attachment loss presented only slight changes without any statistical 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, which is essentially related to a dramatic decrease in serum inflammatory mediators.
Highlights
We detected impaired oral health in all patients included in the final analysis, as follows: all had gingivitis, and different degrees of chronic periodontitis; advanced loss of attachment was reported in up to 23.52% of cases, while increased prevalence of sites with dental plaques in 21.56% of cases
We aimed to assess the influence of the IL-6 receptor inhibitor on periodontal status in active rheumatoid arthritis (RA) associated with periodontitis, assuming that TCZ might be able to improve clinical and biochemical RA-related parameters and to ameliorate chronic periodontitis as a result of decreased IL-6 in the periodontal microenvironment via declining systemic inflammation
Our target is to demonstrate the ability of TCZ to modulate periodontal inflammation and subsequent damage, firstly, we emphasized its role in controlling RA activity
Summary
Rheumatoid arthritis (RA) is an autoimmune condition characterized by joint inflammation and destruction associated with chronic systemic inflammation accounting for significantly impaired quality of life. It is defined by the excessive activation of proinflammatory cytokines mediators, specific autoantibodies and progressive irreversible articular damage [1,2]. The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). Conclusion: IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, which is essentially related to a dramatic decrease in serum inflammatory mediators
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