Effect of Drug Treatment of Rheumatoid Arthritis in Periodontal Conditions

Objectives: To evaluate the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity
Methods: One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-α and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sentitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR).
Results: Anti-TNF-α therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-α therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The numbers of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030). CRP revealed significant associations with BOP when this marker is above 9 mg/L (p=0.05), ESR demonstrated statistically associations with the percentage of periodontal affected sites with PD ≥4 mm (p=0.030).
especially on patients treated with methotrexate and/or other DMARD (p=0.019). ERS also showed significant associations with the presence of red complex bacteria in patients with biological treatment (p=0.004).
Conclusions: Different pharmacological treatments for RA affect the clinical condition and sub-gingival microbiota, modulate the processes of activity at the periodontal level, and correlate to the articular disease activity. Those patients with RA receiving different treatments should be evaluated integrally by rheumatologist and periodontics