| dc.description.abstracteng | The aim of this study was to record clinical periodontal findings according to disease activity (clinical and serological) in patients with rheumatoid arthritis (RA). Furthermore, the influence of different immunosuppressive rheumatic medications on the severity of periodontitis and on the serum level of IL-6 and IL-10 was investigated.
Methods: 152 RA patients (f: 125, m: 27; mean age 59.55 ± 9.82 years) were included in the study.
To determine the periodontal disease burden, the following parameters were collected: number of missing teeth (M-T), average clinical attachment loss (Ø CAL), average probing depths (Ø ST). The classification of the periodontal disease was established based on Ø PD and/or Ø CAL in healthy/mild, moderate or severe periodontitis according to Page and Eke 2007.
The disease activity of RA was determined using the following parameters: age at initial diagnosis, duration of morning stiffness in minutes, disease activity score 28 (DAS28), serum levels of rheumatoid factor (RF), antibodies against cyclic citrullinated peptides (anti-CCP), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
The duration of treatment with the following immunosuppressive RA-medications was recorded in months: 1) methotrexate (MTX), 2) leflunomide, 3) MTX and TNF-α antagonists combined, 4) tocilizumab, 5) MTX and rituximab combined, 6) combinations of > 2 conventional synthetic disease-modifying anti-inflammatory drugs (csDMARDs). In addition, the total duration of therapy with csDMARDs and with biologics was documented in months.
In a sub analysis, the serum concentrations of the cytokines interleukin-6 (IL-6) and interleukin-10 (IL-10) were determined in 80 RA patients (f: 65, m: 15; mean age 64.59 ± 2.24 years) quantified by ELISA depending on the drug therapy with 1) non-steroidal anti-inflammatory drugs (NSAID) and glucocorticoids combined, 2) MTX, 3) leflunomide, 4) MTX and TNF-α antagonists combined, 5) tocilizumab, 6) MTX and rituximab combined, 7) combination therapies of > 2 csDMARDs.
Results: Individuals with increased tooth loss were on average older (p = 0,037) and had a higher mean DAS28 (p = 0,004). A longer duration of morning stiffness correlated with a lower Ø CAL (p = 0,048). With increasing severity of periodontitis the concentration of rheumatoid factor in the blood ascended (p = 0,007). Both, an increased 1h ESR (p = 0,024) value and an increased concentration of rheumatoid factor in the blood (p = 0,023) correlated with higher Ø CAL. Associations with the concentration of anti-CCP or CRP in the blood remained insignificant.
There was no significantly correlation between the duration of use of isolated csDMARDs or biologics and the periodontal parameters (M-T, Ø CAL, Ø ST, periodontal condition according to Page and Eke 2007). The total duration of drug intake was also not significantly associated with one or more of these parameters.
The intake of tocilizumab correlated with an increased concentration of IL-6 in the blood (p = 0,005); the intake of the other drugs had no significant effect on the serum concentrations of IL-6 or IL-10.
Conclusions: The results suggest an association between increased disease activity and reduced periodontal health in RA. The influence of individual parameters on the interrelationship between PA and RA remains unclear. The effect of RA medication on the cytokines IL-6 and IL-10 as well as periodontitis could not be conclusively clarified either. | de |