Periodontal treatment may improve RA activity in the short term

The researchers reviewed 21 studies on the effects of gum disease treatment on various measures of rheumatoid arthritis (RA) activity.

According to a systematic review of the literature published in Advances in rheumatology in practice.

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

“The association of periodontal disease in people diagnosed with RA appears to be an important driver of the autoimmune response in RA,” the study authors explained. “Screening and treatment of periodontal disease may benefit people with RA.”

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

Of these 21 studies, 11 were experimental non-randomised 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 assessed the effects of non-surgical periodontal treatment (NSPT) on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA ), ancillary biomarkers, joint swelling and tenderness, patient-reported outcomes, and adverse events.

Of the studies reporting DAS-28, 9 of them found a statistically significant improvement in DAS-28 after NSPT, compared to baseline. Additionally, of 10 studies with between-group analyses, 6 studies found a statistically significant difference in DAS-28 between 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 results suggest that serum CRP and ESR may have limited applicability as useful indicators for determining the effect of periodontal intervention on systemic markers of inflammation in participants with RA” , they wrote.

Results were inconsistent across the 7 studies measuring FR before and after NSPT and showed high variability within cohorts. With limited clear data, the authors stated that RF does not currently appear to be a reliable biomarker for assessing systemic response to NSPT.

Regarding ACPA, a serological hallmark of RA, 3 out of 6 studies demonstrated a significant within-group improvement in serum ACPA levels after NSPT. Changes in serum levels were seen as early as 4 weeks and sustained results up to 6 months later, according to the study.

After NSPT, 2 studies reported a statistically significant improvement in the number of swollen and tender joints. While 2 studies assessed morning stiffness and 2 assessed a patient health assessment questionnaire, neither found significant improvement in either.

“No adverse events were reported in any of the included studies of NSPT in the study populations,” the authors noted. “However, it is interesting to note that in the study by Monsarrat et al., two participants in the treatment group dropped out due to fears that NSPT could trigger an RA flare.”

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

Reference

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

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