There has been a great deal of interest in potential associations between periodontal disease and a range of systemic diseases. Rheumatoid Arthritis (RA) is one of these.

The aim of this review was to assess whether periodontal treatment could improve biochemical and clinical measures in patients suffering from RA.

Methods

Searches were conducted in the Medline-PubMed, DOSS, Embase, Lilacs, Scopus, Web of Knowledge, MedNar and ProQuest Theses and Dissertations databases.

Studies that examined the effect of periodontal treatment of chronic periodontitis in patients diagnosed with both RA and chronic periodontitis in patients over 30 years of age were considered. Studies had to have a control group with a non-surgical periodontal intervention. Only English language studies were considered. Studies were selected and methodological quality was assessed by 3 reviewers.

Diagnosis of periodontal disease was based on the clinical and radiographic criteria described by the 1999 Consensus Classification of Periodontal Diseases, while diagnosis of RA was based on criteria of the American College of Rheumatology.

The outcome of interest was the influence of non-surgical periodontal treatment on clinical and biochemical measures for RA disease activity.

Results

• 5 studies were included. Follow up ranged from 6 weeks to 6 months.
• Sample sizes in the treatment arm ranged from 10-26 and 10-29 in the control arm.
• Measures of RA disease activity in the studies included DAS28, ESR, CRP, ACPA, RF, TNF-α, IL-1 and IL-6.
• Non-surgical periodontal treatment was associated with significant reductions in erythrocyte sedimentation rate and a trend towards a reduction in TNF-α titres and DAS scores.
• There was no evidence of an effect on RF, C-reactive protein, anti-cyclic citrullinated protein antibodies and IL-6.

Conclusion

The authors concluded:

Based on clinical and biochemical markers, non-surgical periodontal treatment in individuals with periodontitis and RA could lead to improvements in markers of disease activity in RA. All studies had low subject numbers with the periods of intervention no longer than 6 months. Larger studies are required to explore the effect of non-surgical periodontal treatment on clinical indicators of RA, using more rigorous biochemical and clinical outcome measures as well as giving consideration to potential confounding factors of co-morbidity.

Commentary

As the authors note all the included studies has small sample sizes and were of relatively short duration. The discussion suggests that only one of the included studies was not randomised but it is not clearly stated that the other studies are randomised controlled trials although they all have control groups.

Association between periodontal disease and wide range of systemic diseases have been proposed and a summary paper by Liden et al (2013) from the Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology suggested that there was little evidence that periodontitis represents a risk factor for RA.

A systematic review by Kaur et al (2013) did however suggest potential associations between periodontal disease and rheumatoid arthritis, although they did point out that the majority of the studies included in their review were case-controls with low sample sizes.

Links

Kaur S, Bright R, Proudman SM, Bartold PM. Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Apr 28. pii: S0049-0172(14)00070-5. doi: 10.1016/j.semarthrit.2014.04.009. [Epub ahead of print] Review. PubMed PMID: 24880982.

Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Clin Periodontol. 2013 Apr;40 Suppl 14:S8-19. doi: 10.1111/jcpe.12064. PubMed PMID: 23627336.

Kaur S, White S, Bartold PM. Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res. 2013 May;92(5):399-408. doi: 10.1177/0022034513483142. Epub 2013 Mar 22. Review. PubMed PMID: 23525531.