Periodontitis and rheumatoid arthritis: A neglected association in developing countries

Most patients with rheumatoid arthritis (RA), one of the most common inflammatory diseases, also suffer from periodontitis. This study investigated the effects of periodontal therapy on disease activity in RA patients. In this before-and-after clinical trial study, 30 patients with simultaneous RA and periodontitis were studied from March 2014 to February 2016. The Disease Activity Score with 28-joint Counts (DAS28) questionnaire was completed for all participants. Patients with confirmed periodontitis received non-surgical scaling, root planning, systemic antibiotics, and chlorhexidine. At days 45 and 90 after treatment, the DAS28, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured again. The results of the evaluation of 30 patients with a mean age of 50.2±10.62 years (80% female) showed that the difference in the level of disease activity between baseline versus 45 (5.18±0.092 vs. 4.02±1.22, P value<0.001) and 90 days later (5.18±0.092 vs. 3.84±0.92, P value<0.001), was statistically significant. Serum CRP levels (mg/dl) were lower at 90 days after treatment (5.17±2.96) than at 40 days post-treatment (5.30±3.59). The ESR values (mm/hour) at 45 (20.57±11.01) and 90 (18.23±8.99) days after periodontal therapy were lower in comparison with the baseline (21.67±11.65), but there were no significant differences between the different time points (P value˃0.05). Treating periodontitis resulted in reduced RA disease activity. Hence, routine dental examinations for faster diagnosis and treatment of periodontitis in order to relieve RA symptoms as well as further studies including a control group are recommended.