Effect of Periodontal Therapy on Rheumatoid Arthritis Patients Receiving Anti-TNF-a

OBJECTIVE: a) To examine the effect of periodontal treatment on severity of rheumatoid arthritis (RA) in patients receiving disease-modifying anti-rheumatic drugs (DMARDs) alone or in combination with anti-TNF-a therapy; (b) to assess the effect of anti-TNF-a therapy on the periodontal condition. METHODS: Forty subjects diagnosed with moderate to severe RA and chronic periodontitis were included. Subjects were randomized in one of two groups (20 each): Group I: Periodontal treatment (10 subjects on DMARDs alone and another 10 on DMARDs + anti-TNF-a therapy); Group II: No Periodontal treatment (10 subjects on DMARDs alone and another 10 on DMARDs + anti-TNF-a therapy). Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival (GI) and plaque (PI) indices were assessed. RA activity was evaluated using disease activity score (DAS-28) and erythrocyte sedimentation rate (ESR). Serum levels of TNF-a also were recorded using high sensitivity ELISA (R&D systems). All data were collected at baseline and six weeks after periodontal treatment. RESULTS: 1) In Group I, there is significant decrease between pre- and post-periodontal treatment (p<0.0001) in the mean DAS28 (5.02 vs. 3.53), ESR (51.5 vs. 16.5); and serum TNF-a (77.79 vs. 42.84), (<0.05). 2) In Group II, there is no statistically significant difference in periodontal and RA parameters. 3) Anti-TNF-a therapy resulted in a significant improvement in all periodontal (p<.05) and RA (p<0.01) parameters. 4) Significant difference was found (p<0.05) in the decrease of the levels of TNF-a between Group I and II. CONCLUSIONS: a) Control of periodontal infection/inflammation reduces the severity of RA; and b) anti-TNF-a therapy improves periodontal health.