Abstract
Interleukin‐6 (IL‐6) may play a pathological role in rheumatoid arthritis (RA) and periodontitis. Although the efficacy of medication with IL‐6 receptor inhibitor, tocilizumab (TCZ), has been demonstrated in the treatment of RA, very little is known about whether TCZ therapy affects periodontitis. The aim of the present study is to compare periodontal condition in patients with RA and periodontitis before and after TCZ therapy. The study participants consisted of 20 patients with RA and periodontitis who were treated with TCZ and 40 patients with RA and periodontitis who received medication with tumor necrosis factor inhibitor (TNFI). Clinical periodontal and rheumatologic assessments and serum biochemical measurements using enzyme‐linked immunosorbent assays were performed at baseline and 3 and 6 months later. TCZ and TNFI therapies significantly reduced periodontal inflammation that was determined by gingival index, bleeding on probing, and probing depth (p < 0.017), although plaque levels were comparable before and after the therapies. Both therapies also significantly decreased disease activity score including 28 joints using C‐reactive protein (CRP), number of tender and swollen joints, and serum levels of anti‐cyclic citrullinated peptide antibodies, rheumatoid factor, CRP, and matrix metalloproteinase‐3 (p < 0.017). Additionally, a significant decrease was observed in periodontal clinical attachment level after TCZ therapy (p < 0.017), but not after TNFI therapy. TCZ therapy significantly decreased serum levels of TNF‐α, total immunoglobulin G, and serum amyloid A (p < 0.017), although serum levels of IL‐6 and soluble IL‐6R were significantly increased (p < 0.017). These results suggest a beneficial effect of TCZ therapy on levels of periodontal inflammation in patients with RA and periodontitis, which might be related to decrease in serum inflammatory mediators.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and joint tissue destruction, which results in functional disability
Comparison between the groups at baseline No significant differences were observed at baseline between the TCZ and tumor necrosis factor inhibitor (TNFI) groups in any demographic, periodontal, and rheumatologic parameter values (p > 0.05) (Table 1)
RA, rheumatoid arthritis; TCZ, tocilizumab; TNFI, tumor necrosis factor inhibitor; SD, standard deviation; n, number; GI, gingival index; BOP, bleeding on probing; PD, probing depth; CAL, clinical attachment level; DAS28-CRP, disease activity score including 28 joints using C-reactive protein; DMARD, disease-modifying antirheumatic drugs; non-steroidal antiinflammatory drugs (NSAIDs), non-steroidal anti-inflammatory drugs; CCP, cyclic citrullinated peptide; RF, rheumatoid factor; MMP, matrix metalloproteinase. *The p-value was assessed by Mann–Whitney U-test between the groups
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and joint tissue destruction, which results in functional disability. Periodontitis represents a chronic inflammatory disease that affects toothsupporting tissues and is initiated by infection with oral anaerobic bacteria. Both diseases are common chronic inflammatory conditions and share many clinical and pathologic features (Bartold et al, 2005; de Pablo et al, 2009). IL-6R and TNF Blockade and Periodontitis periodontitis (Bartold et al, 2005; de Pablo et al, 2009) These observations suggest that certain features of the inflammatory responses are common to both diseases, which might be underpinned by biologic pathways
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