Periodontal Treatment May Improve Short-term RA Disease Activity

There is some evidence that periodontal treatment improves short-term rheumatoid arthritis (RA) disease activity, according to a systematic literature review published in Rheumatology Advances in Practice.

Gum disease is more prevalent in individuals with RA. If untreated, it can lead to pain, infection, and possibly tooth loss.

“The association of periodontal disease in people diagnosed with RA is emerging as an important driver of the RA autoimmune response,” the study authors explained. “Screening for and treating periodontal disease might benefit people with RA.”

Following a database search and quality check, the authors analyzed 21 studies on the effects of periodontal treatment, or the professional cleaning of the pockets around teeth to prevent surrounding bone damage and treat gum disease, on various RA disease activity measures.

Of these 21 studies, 11 were nonrandomized experimental design trials and 10 were randomized controlled trials. DAS-28 was the primary outcome in 17 studies, and study quality ranged from low to critical levels of bias.

The studies also evaluated the effects of nonsurgical periodontal treatment (NSPT) on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti–citrullinated protein antibodies (ACPA), ancillary biomarkers, swollen and tender joint counts, patient-reported outcomes, and adverse events.

Out of the studies reporting DAS-28, 9 of them found a statistically significant improvement in DAS-28 following NSPT, compared with baseline. Additionally, of 10 studies with intergroup analyses, 6 studies found a statistically significant difference in DAS-28 between the experimental and control arms.

Some studies also found significant reductions in CRP and ESR, although there was high intragroup variability, the authors found.

“Taken together, these findings suggest that serum CRP and ESR might have limited applicability as useful indicators in determining the effect of a periodontal intervention on systemic markers of inflammation in participants with RA,” they wrote.

Results were inconsistent across the 7 studies measuring RF before and after NSPT and had high variability within cohorts. With limited clear data, the authors said RF does not currently appear to be a reliable biomarker to assess systemic response to NSPT.

Regarding ACPA, a serological hallmark of RA, 3 of 6 studies demonstrated significant intragroup improvement in serum ACPA levels following NSPT. Changes in serum levels were seen as early as 4 weeks and sustained results up to 6 months after, depending on the study.

After NSPT, 2 studies reported statistically significant improvement in swollen and tender joint counts. While 2 studies evaluated early morning stiffness and 2 evaluated a patient heath assessment questionnaire, none of them found significant improvements in either.

“There were no adverse events reported in any of the included studies from NSPT in the study populations,” the authors noted. “Of interest, however, in the study by Monsarrat et al., two participants from the treatment group dropped out owing to the concerns that NSPT might trigger an RA flare.”

According to the authors, additional, high-quality research is needed on the subject.

Reference

Mustufvi Z, Twigg J, Kerry J, et al. Does periodontal treatment improve rheumatoid arthritis disease activity? a systematic review. Rheumatol Adv Pract. Published online August 17, 2022. doi:10.1093/rap/rkac061