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Periodontal disease diminished anti-TNF efficacy in patients with RA
Periodontal disease hampered anti-tumor necrosis factor efficacy in patients with rheumatoid arthritis, according to results of a recent study.
The longitudinal, 6-month study included 18 patients (94.4% female; median age 50 years) with rheumatoid arthritis (RA) for a median duration of 10.5 years. Patients were assessed for periodontal disease (PD) at baseline and after 6 months of anti-tumor necrosis factor (TNF) therapy. Treatment included infliximab (n=15), adalimumab (n=2) or etanercept (n=1). Periodontal assessment, conducted by a dentist at six sites per tooth, included indices for plaque and gingival bleeding, probing pocket depth, cementoenamel junction and clinical attachment level. Masked to dental assessments, demographic data, clinical manifestations, Disease Activity Score (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were included in a rheumatologic evaluation.
Eight patients were diagnosed with PD. Periodontal parameters for the entire cohort remained stable (P>.05) during the study, while RA assessments improved, but were restricted to the non-PD patients for DAS28 (5.5 vs. 3.6; P=.04), ESR (23.0 mm/first hour vs. 11.5 mm/first hour; P=.008) and CRP (7.4 vs. 2.1; P=.01). By comparison, PD patients lacked response and showed no statistically significant differences in DAS28 (5.2 vs. 4.4; P=.11), ESR (17.0 mm/first hour vs. 21.0 mm/first hour; P=.56) and CRP (9.0 vs. 8.8; P=.55).
“This study supports the notion that PD may affect TNF blocker efficacy in patients with RA,” the researchers concluded. “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.”