Creaky Joints and Bleeding Gums: The Interactions between Periodontal Disease and Rheumatoid Arthritis (RA)
The Effect of Periodontal Therapy on RA Disease Activity

The effect of periodontal treatment on RA disease activity is inconclusive given the current body of scientific literature. A recent systematic review evaluating the effect of periodontal treatment on RA disease activity determined the methods of evaluating RA disease activity varied greatly between studies, and all evaluated studies had a low number of subjects.⁸⁸ In this analysis, erythrocyte sedimentation rate (ESR) and TNF-α demonstrated a statistically significant reduction following nonsurgical periodontal therapy, but no such reduction was seen in CRP, ACPA, or rheumatoid factor (RF).⁸⁸ This may be due to ACPA’s role in the initiation of RA and the reduction due to decreased periodontal inflammation and/or microbial burden may need to occur earlier to yield a benefit.

Non-surgical periodontal therapy has also been shown to decrease GCF levels of IL-1β, serum TNF-α levels, and DAS and in patients with RA and chronic periodontitis.^88-92 Furthermore, while individual small-scale case-control studies have demonstrated improvements in CRP levels and ESR after nonsurgical periodontal therapy in patients with RA and chronic periodontitis, the overall CRP and ESR values remained higher than those of the controls.⁹⁰ An ongoing large-scale clinical trial Experimental Study of Periodontitis and Rheumatoid Arthritis (ESPERA), is seeking to evaluate the effects of nonsurgical periodontal therapy on RA and periodontitis outcomes as well as biomarkers in patients with RA and chronic periodontitis.⁹³ This study may further elucidate the mechanisms of interaction and highlight methods for treatment.