Background Overlapping molecular pathways of inflammation have been implicated in periodontitis and rheumatoid arthritis (RA). The presence of shared underlying inflammatory pathogenesis mediating the progression of periodontitis and RA could provide potentially important common therapeutic targets.
Objectives The primary purpose of this observational study was to determine the effect of methotrexate (MTX) and anti-TNFα (etanercept) on clinical parameters of periodontitis. Influence of periodontitis on efficacy of medical treatment of RA was a secondary endpoint.
Methods Fourteen treatment-naïve patients starting with MTX and 12 patients starting with anti-TNFα therapy, fulfilling the ACR/EULAR classification criteria for RA (2010), older than 18 years, and with natural dentition were included. One patient was excluded because of antibiotic use for oral infection <3 months prior to the study. Four patients stopped treatment with etanercept after the first follow up visit because of patient related factors. Before starting medical treatment for RA and after 2 months (MTX) or 3 months (anti-TNFα), periodontal inflammatory burden was quantified with the periodontal inflamed surface area (PISA) (Nesse et al. 2008). Subgingival presence of P. gingivalis was determined by anaerobic culture. In addition, radiographic intra-oral pathologies (furcation involvement, peri-apical pathology and cariës) were assessed on panoramic radiographs. Oral hygiene was measured using full mouth plaque scores. Efficacy of anti-rheumatic treatment was measured by change in RA disease activity (DAS28-ESR).
Results Treatment with MTX of anti-TNFα significantly improved DAS scores (both p<0.001) and erythrocyte sedimentation rates (ESR) (both p<0.05). PISA did not change significantly after starting with treatment with MTX or anti-TNFα. Also, PISA or presence of other intra-oral pathologies were not associated with changes in DAS scores and ESR
Conclusions Anti-rheumatic treatment did not have significant impact on clinical periodontal parameters. Within the limitations of this study (PISA scores were rather low) PISA and presence of other intra-oral pathologies were not of associated with efficacy of anti-rheumatic treatment.
Nesse, W., Abbas, F., van der Ploeg, I., Spijkervet, F.K., Dijkstra, P.U. & Vissink, A. (2008) Periodontal inflamed surface area: quantifying inflammatory burden. J.Clin.Periodontol. 35, 668–673.
Disclosure of Interest M. de Smit: None declared, M. Posthumus: None declared, A.-M. van Brenk: None declared, L. Oosting: None declared, G. Springer: None declared, E. Brouwer: None declared, M. Bijl Grant/research support from: Pfizer, J. Westra: None declared