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Periodontal disease hindered anti-TNF response in patients with rheumatoid arthritis
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Periodontal disease reduced the efficacy of tumor necrosis factor blocker in patients with rheumatoid arthritis compared with those without periodontal disease, according to a recent study.
Researchers conducted a longitudinal study of 18 patients (median age, 50 years; median disease duration, 10.5 years; 94.4% women) with rheumatoid arthritis (RA). Patients were assessed for periodontal disease at baseline and 6-month follow-up after first-time treatment with anti-tumor necrosis factor (a-TNF). Infliximab was assigned to 15 patients, two were treated with adalimumab, and one was assigned etanercept.
Patients’ periodontal data included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Blinded to dental assessments, rheumatologic evaluations examined demographic data, clinical manifestations, and disease activity, including Disease Activity Score of 28 joints (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
Periodontal disease was diagnosed in 44% of patients, and those parameters remained stable when matching baseline and follow-up for the entire cohort (P>.05). After analyzing RA parameters, researchers learned that improvements from baseline compared with follow-up were significant but limited to patients without periodontal disease for median 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 mg/dL vs. 2.1 mg/dL, P=.01).
Patients with periodontal disease lacked response and showed no significant differences in disease activity between baseline and follow-up for 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 mg/dL vs. 8.8 mg/dL, P=.55).
“This study supports the notion that an underlying PD may affect [a-TNF] efficacy in patients with RA,” 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.”
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