Influence of anti-rheumatic agents on the periodontal condition of patients with rheumatoid arthritis and periodontitis: A systematic review and meta-analysis.

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Tytuł:: Influence of anti-rheumatic agents on the periodontal condition of patients with rheumatoid arthritis and periodontitis: A systematic review and meta-analysis.
Autorzy:: Zhang J; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Xu C; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Gao L; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Zhang D; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Li C; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Liu J; Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China.
Źródło:: Journal of periodontal research [J Periodontal Res] 2021 Dec; Vol. 56 (6), pp. 1099-1115. Date of Electronic Publication: 2021 Sep 12.
Typ publikacji:: Journal Article; Meta-Analysis; Systematic Review
Język:: English
Imprint Name(s):: Publication: Malden, MA : Wiley-Blackwell
Original Publication: Copenhagen : Munksgaard International Publishers
MeSH Terms:: Antirheumatic Agents*/therapeutic use
Arthritis, Rheumatoid*/complications
Arthritis, Rheumatoid*/drug therapy
Chronic Periodontitis*/complications
Chronic Periodontitis*/drug therapy
Humans ; Periodontal Attachment Loss/drug therapy ; Periodontal Index ; Tumor Necrosis Factor Inhibitors
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Contributed Indexing:: Keywords: anti-B lymphocytes; anti-TNF-α; anti-rheumatic agents; gingival inflammation; periodontitis; rheumatoid arthritis
Substance Nomenclature:: 0 (Antirheumatic Agents)
0 (Tumor Necrosis Factor Inhibitors)
Entry Date(s):: Date Created: 20210913 Date Completed: 20211119 Latest Revision: 20211119
Update Code:: 20240105
DOI:: 10.1111/jre.12925
PMID:: 34514591
: Czasopismo naukowe

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Objective: To evaluate the influence of diverse anti-rheumatic agents on the periodontal condition and to provide clinical medication guidance for patients with rheumatoid arthritis (RA) and periodontitis.
Background: In recent years, the correlation between RA and periodontitis has become a hot research topic, but no medication recommendations for patients with RA and periodontitis are available at present.
Methods: The protocol of this review was registered in advance with PROSPERO (CRD42021248827). Electronic search and manual searches up to March 20, 2021 were conducted. The inclusion criteria for the studies were as follows: included patients diagnosed with periodontitis and RA submitted to anti-rheumatic agent therapy; with a control group receiving no anti-rheumatic agent therapy; with outcomes including at least one periodontal parameter. Probing depth (PD) and clinical attachment loss (CAL) were pooled using weighted mean difference (WMD) and 95% confidence intervals (CI) while gingival index (GI)/modified gingival index (MGI) was analyzed by standardized mean difference (SMD) and 95% CI.
Results: One thousand four hundred and seventy-eight studies potentially related to the aim of this review were screened, but only 463 patients from 14 studies were included in the qualitative analysis, and 146 patients from 4 studies were included in the meta-analysis. Statistically significant reductions were observed among the subjects who received anti-rheumatic agents for PD [WMD = -0.20; 95% CI (-0.33, -0.07); effect p = .003; I 2 = 50%; p = .11], CAL [WMD = -0.4; 95% CI (-0.66, -0.15); effect p = .002; I 2 = 57%; p = .07] and GI/MGI [SMD = -0.61;95% CI (-0.94, -0.27; effect p = .0004; I 2 = 26%; p = .25]. Consistent with the above results, this systematic review produced promising results that PD, CAL, GI/MGI, and bleeding on probing (BOP) decreased when patients with RA and periodontitis were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), anti-B lymphocyte agents, anti-IL-6R agents, or JAK inhibitors. PD and CAL declined after the administration of anti-TNF-α agents; most studies reported decreased GI/MGI and BOP, while 2 studies reported increased GI/MGI and BOP.
Conclusions: These results revealed that csDMARDs, anti-B lymphocyte agents, anti-IL-6R agents, anti-TNF-α agents, and JAK inhibitors had potential positive effects in improving the periodontal condition of patients with RA and periodontitis. However, future research is needed to elucidate whether anti-TNF-α agents have a side effect of increased gingival inflammation.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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