Due to the high inflammatory burden associated with both RA70 and chronic periodontitis71 and the potential bidirectional influence this inflammation may have on the treatment of these conditions, it is critical to thoroughly assess and quantify the periodontal inflammatory burden to establish adequate baseline and therapy end points. This may include calculation of PISA scores,72,95 salivary or gingival crevicular fluid (GCF) biomarker sampling, and evaluation of subgingival plaque for the presence of P. gingivalis. This information can help with medication selection for RA treatment as well as improved monitoring for periodontal disease progression.
While the use of PISA scores and advanced biologic sampling may not be necessary in all cases of periodontal disease, incorporation of more in depth analysis of the periodontal inflammatory burden and underlying etiologic agents present may be critical to allow for more precise evaluation of overall periodontal inflammation and to assess the resultant changes after nonsurgical and/or surgical periodontal therapy. Additionally, coordination of care for patients with RA and chronic periodontitis and screening of RA patients for periodontitis should be performed in conjunction with the patients’ rheumatologist or treating physician and periodontal practitioner to allow for assessment of the risks and benefits of therapy for each individual patient based upon their overall condition.
Accurate calculation of the overall inflammatory burden may also be critical in decision making by the patient’s treating physician for drug selection as TNF-α blockers may be less effective in patients with RA and an inflammatory burden from active periodontal disease.72,96,97 Furthermore, the side effects of other medications could results in an unfavorable environment for invasive periodontal therapy.83