Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients. Periodontal infection as a possible severity factor for rheumatoid arthritis. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Persistent Periodontal Disease Hampers Anti–Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis Periodontal treatment decreases levels of antibodies to Porphyromonas gingivalis and citrulline in patients with rheumatoid arthritis and periodontitis.
OBJECTIVE This observational prospect i ve cohort study aim ed to evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements and systemic inflammatory mediator levels in low or moderate to highly active rheumatoid arthritis ( RA ) patients with chronic periodontitis . SUBJECTS AND METHODS Rheumatoid arthritis activity was assessed with disease activity score test ( DAS28 ) . Thirty patients with RA with moderate to high disease activity ( DAS28 ≥ 3.2 ) and chronic periodontitis ( MHDA group ) and thirty patients with RA with low disease activity ( DAS28 < 3.2 ) and chronic periodontitis ( LDA group ) were enrolled in the study . The patients were monitored at the beginning and 3 months after undergoing periodontal therapy . Erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , tumour necrosis factor-alpha ( TNF-α ) levels in serum , DAS28 and periodontal parameters were evaluated . RESULTS Erythrocyte sedimentation rate , CRP , TNF-α levels in serum , DAS28 and periodontal parameters exhibited similar and significant reduction 3 months after the non-surgical periodontal treatment . CONCLUSION Non-surgical periodontal treatment may prove beneficial in reducing RA severity as measured by ESR , CRP , TNF-α levels in serum and DAS28 in low or moderate to highly active RA patients with chronic periodontitis OBJECTIVE Clinical effects of periodontal treatment on biochemical and clinical markers of disease severity in rheumatoid arthritis ( RA ) patients with periodontal disease were evaluated . METHODS Forty-two patients were assigned to two groups , G1 ( n=16 ) and G2 ( n=26 ) . G1 patients were su bmi tted to oral hygiene instruction and professional tooth cleaning and G2 patients additionally had full-mouth scaling and root planing ( SRP ) . Clinical periodontal measurements were obtained at baseline and 3 months after periodontal treatment . A Health Assessment Question naire ( HAQ ) was used to evaluate their performance on daily living . Rheumatoid factor ( RF ) , erythrocyte sedimentation rate ( ESR ) and drug therapy were assessed . RESULTS Both groups presented a full-mouth improvement in all periodontal clinical parameters ( p<0.05 ) , with the exception of clinical attachment level ( CAL ) and probing pocket depth ( PPD ) > 6 mm for G1 . G2 showed greater mean reductions on PPD > 4 mm than G1 ( p<0.001 ) . HAQ analyses showed a reduction on the degree of disability of G2 , but not statistically significant . ESR was significantly reduced for G2 after SRP although RF did not show statistical reductions . CONCLUSION The data suggest that periodontal treatment with SRP might have an effect on the ESR reduction Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Objective This study aim ed to evaluate prospect ively the influence and the evolution of periodontal disease ( PD ) in rheumatoid arthritis ( RA ) patients su bmi tted to anti – tumor necrosis factor ( TNF ) therapy .  Methods Eighteen patients with RA ( according to the American College of Rheumatology criteria ) were assessed for PD before ( BL ) and after 6 months ( 6 M ) of anti-TNF treatment : 15 infliximab , 2 adalimumab , and 1 etanercept .  Periodontal assessment included plaque and gingival bleeding indices , probing pocket depth , cementoenamel junction , and clinical attachment level . Rheumatologic evaluation was performed blinded to the dentist ’s assessment : demographic data , clinical manifestations , and disease activity ( Disease Activity Score using 28 joints [ DAS28 ] , erythrocyte sedimentation rate [ ESR ] , and C-reactive protein [ CRP ] ) . Results The median age and disease duration of patients with RA were 50 years ( 25–71 y ) and 94 % were female .  Periodontal disease was diagnosed in 8 patients ( 44.4 % ) . Comparing BL to 6 M , periodontal parameters in the entire group remained stable ( P > 0.05 ) throughout the study ( plaque and gingival bleeding indices , probing pocket depth , cementoenamel junction , and clinical attachment level ) , whereas an improvement in most analyzed RA parameters was observed in the same period : DAS28 ( 5.5 vs. 3.9 , P = 0.02 ) , ESR ( 21 vs. 12.5 mm/first hour , P = 0.07 ) , and CRP ( 7.8 vs. 2.8 mg/dL , P = 0.25 ) . Further analysis revealed that this improvement was restricted to the group of patients without PD ( DAS28 [ 5.5 vs. 3.6 , P = 0.04 ] , ESR [ 23.0 vs. 11.5 mm/first hour , P = 0.008 ] , and CRP [ 7.4 vs. 2.1 , P = 0.01 ] ) . In contrast , patients with PD had lack of response , with no significant differences in disease activity parameters between BL and 6 M : DAS28 ( 5.2 vs. 4.4 , P = 0.11 ) , ESR ( 17.0 vs. 21.0 , P = 0.56 ) , and CRP ( 9.0 vs. 8.8 , P = 0.55 ) . Conclusions This study supports the notion that PD may affect TNF blocker efficacy in patients with RA . The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition BACKGROUND Porphyromonas gingivalis has been implicated as an etiologic agent of rheumatoid arthritis ( RA ) because of the expression of peptidylarginine deiminase . The present study evaluates whether periodontal treatment may affect serum antibodies to P. gingivalis and citrulline levels in relation to disease activity of RA . METHODS Fifty-five patients with RA were r and omly assigned to receive oral hygiene instruction and supragingival scaling ( treatment group , n = 26 ) or no periodontal treatment ( control group , n = 29 ) . Periodontal and rheumatologic parameters and serum levels of cytokine and inflammatory markers citrulline and immunoglobulin (Ig)G to P. gingivalis were examined at baseline and 8 weeks later . RESULTS Both groups did not differ statistically in any parameters except percentage of sites with probing depth and clinical attachment level ≥ 4 mm at baseline . The treatment group exhibited a significantly greater decrease in disease activity score including 28 joints using C-reactive protein ( DAS28-CRP ) ( P = 0.02 ) , serum levels of IgG to P. gingivalis hemin binding protein (HBP)35 ( P = 0.04 ) , and citrulline ( P = 0.02 ) than the control group . Serum levels of IgG to P. gingivalis HBP35 were significantly correlated positively with those of anti-cyclic citrullinated peptide antibodies ( P = 0.0002 ) . The same correlation was obtained between serum levels of IgG to P. gingivalis-sonicated extracts and those of rheumatoid factor ( P = 0.02 ) . CONCLUSIONS These results suggest that supragingival scaling decreases DAS28-CRP and serum levels of IgG to P. gingivalis HBP35 and citrulline in patients with RA . These observations may reflect a role of P. gingivalis in the protein citrullination , which is related to the pathogenesis of RA
OBJECTIVE To evaluate the influence of periodontal treatment on rheumatoid arthritis activity .