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Title Non-surgical Periodontal Treatment in Individuals with Periodontal Disease and Rheumatoid Arthritis (RA) Leads to Improvements in Markers of RA Disease Activity
Clinical Question For patients with rheumatoid arthritis (RA) and periodontal disease (PD), does non-surgical periodontal therapy impact the patient’s rheumatic health based on biochemical and clinical parameters of RA?
Clinical Bottom Line With non-surgical periodontal treatment in patients with RD and RA, there is a positive effect on multiple biochemical and clinical parameters of RA; this conclusion is based on the results of three systematic reviews.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23525531Kaur / 201319 studies included in SR, 12/19 included in MASystematic Review and Meta-analysis
Key resultsThis systematic review investigated the association between periodontal disease (PD) and rheumatoid arthritis (RA). The study designs included 16 case-control and 3 experimental studies; it is to be noted that the majority were of low study population size. The review determined that there is a significant association between periodontal disease and rheumatoid arthritis, and a statistically signicant improvement in the erythrocyte sedimentation rate (ESR) RA biochemical marker following non-surgical periodontal treatment.
#2) 24880982Kaur / 20145 studies included in SR, number of studies included for MA varied between biomarkersSystematic Review and Meta-analysis
Key resultsA continuation of the previous systematic review, the aim was to further assess studies related to whether periodontal treatment could improve biochemical and clinical measures in patients suffering from RA. The study design included 5 original research papers, all single-centre intervention studies. The review determined that non-surgical periodontal treatment was associated with significant reductions in ESR and a trend towards a reduction in TNF-α titres and disease activity scores (DAS/DAS28); however, there is no evidence of an effect on rheumatoid factor (RF), C-reactive protein, anti-cyclic citrullinated protein antibodies (ACPA), and IL-6. Meta-analysis, performed when standard deviations were available, verified associated effects of non-surgical periodontal treatment on RA biochemical markers; DAS scores (n=5), ESR (n=4), CRP (n=3), TNF-α (n=2) and RF (n=2). Due to only one study reporting ACPA, RF, and IL-6, no MA was performed for these markers.
#3) 28535896Calderaro / 20175 studies included in SR, 4/5 included in MASystematic Review and Meta-analysis
Key resultsThis systematic review and meta-analysis looked to further investigate the association between PD and RA with respect to non-surgical periodontal treatment and its effects on biochemical markers of RA. A statistically significant reduction of DAS following non-surgical periodontal treatment was found, with an odds ratio (OR) of -1.18 (95% CI: −1.43, −0.93; p < 0.00001). Additionally it was found that ESR, CRP, patient’s assessment of rheumatoid activity using visual analogical scale (VAS), and tender (TJC) and swollen (SJC) joint counts showed a trend toward reduction (which was not statistically significant).
Evidence Search Rheumatoid arthritis & periodontal disease treatment
Comments on
The Evidence
Although two of the systematic reviews only included five studies, the review protocols for both were thorough and any disagreements amongst evaluators documented. The limitations of all three systematic reviews was the need for larger study population sizes and evolving clinical parameters over time as more biomarkers for RA have been identified. Further studies with large population sizes and standardized clinical parameters for assessment are needed to provide a more in-depth evaluation of the relationship between treatment for PD and RA status.
Applicability While an association between periodontal disease and rheumatoid arthritis is evident, the exact biochemical relationship between the two is still to be further discovered. Regardless, all studies indicate that there is a positive alteration in multiple biochemical markers of RA when non-surgical periodontal treatment is preformed in patients that suffer from both PD and RA. Providing such therapy will not only benefit the patient’s periodontal health, but their rheumatic health as well.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Rheumatoid arthritis, periodontal disease treatment, periodontal diseases
ID# 3453
Date of submission: 11/30/2020spacer
E-mail hallh1@livemail.Uthscsa.edu
Author Hali Rashelle Hall, DMD
Co-author(s) Mashael Al Thunayan, DMD
Co-author(s) e-mail althunayan@uthscsa.edu
Faculty mentor/Co-author Dan Lee, DMD
Faculty mentor/Co-author e-mail Dlee625@gmail.com
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