Some Rheumatoid Arthritis Medications Linked to Periodontal Inflammation

Rheumatoid arthritis medication is associated with periodontal inflammation without differences in periodontal disease severity.

Different immunosuppressive medications for patients with rheumatoid arthritis (RA) are associated with the degree of gingival and periodontal inflammation, but not with the severity of periodontal disease, according to results published in the Journal of Periodontology.

Specifically, the combination of methotrexate (MTX) plus tumor necrosis factor alpha (TNF-α) antagonists increases the potential for periodontal inflammation.

The study included participants with RA (n=168) undergoing treatment with different immunosuppressive medications. Participants were divided into 7 groups. 

The first group included participants taking nonsteroidal anti-inflammatory drugs and glucocorticoids combined. The rest of the groups were treated with different disease-modifying antirheumatic drugs(DMARDs), including MTX, leflunomide, MTX and TNF-α antagonists combined, interleukin-6 antagonists, MTX and rituximab combined, and combination therapies of more than 2 DMARDs. Each participant underwent a periodontal examination, including papilla bleeding index, periodontal status with periodontal probing depth, bleeding on probing, and clinical attachment loss.

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Participants taking MTX and TNF-α antagonist therapy had higher papilla bleeding index and bleeding on probing values compared with participants receiving leflunomide (P <.01) and higher bleeding on probing compared with participants receiving MTX with rituximab (P =.02).

Porphyromonas gingivalis (P <.01), Treponema denticola (P <.01), Fusobacterium nodatum (P =.02), sand Capnocytophaga species (P =.05) were associated with medication subgroups.

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Ziebolz D, Rupprecht A, Schmickler J, et al. Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis – results from a cross-sectional study [published online May 22, 2018].  J Periodontol. doi:10.1002/JPER.17-0616