Both RA and periodontal disease are associated with an increased inflammatory burden.70,71 RA subjects demonstrate higher levels of bleeding on probing (BOP) and higher pro-inflammatory cytokines, such as IL-1β and TNF-α levels in GCF than healthy controls.9 As the intrasulcular epithelial surface area differs between tooth type and location, periodontal inflamed surface area, PISA, aimed to measure the inflamed epithelial tissues.72 In an observational study, mean PISA scores were 291.9 mm2 ± 328.7 in a cohort of patients with RA and 94% of RA patients in this study had moderate to severe periodontitis, as opposed to having mild or no periodontitis, which is higher than PISA findings in systemically healthy patients demonstrated in other studies.73 Similarly, in a group of patients with RA, PISA has been correlated with DAS on a linear regression model.74 While the latter finding was not statistically significant, it is consistent with other reports that correlate DAS with BOP and alveolar bone loss. These data in aggregate may indicate a positive, albeit weak, correlation was shown between periodontal disease and RA and the inflammation associated with both.
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