Periodontitis and Rheumatoid Arthritis: Their Bidirectional Outcome of Treatment : A Narrative Review Periodontitis and Rheumatoid Arthritis: Outcome of Treatment : A Narrative Review
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Abstract
Rheumatoid arthritis (RA) and periodontitis(Pd) share numerous biological and immunological interactions, making them closely linked across multiple pathophysiological aspects. The severity and activity of each disease have a tangible impact on the other. Accordingly, the treatment of one condition should also have a positive effect on the other. This review aims to illustrate the outcomes of treating Pd in rheumatoid arthritis and vice versa, given the bidirectional relationship between the two conditions. Method: a recent systematic review and studies involving the treatment outcome of the two conditions on each other have been evaluated. Result: regardless of the type of treatment used, it has been shown that treating periodontitis can decrease the activity of RA, and on the same manner treating RA can improve the periodontal breakdown. Conclusion: it is advised that periodontal assessment be performed for all RA patient for an early diagnosis and treatment of any periodontal problems, similarly, for periodontal patients who have RA the activity of RA should be investigated and managed to control periodontal distraction.
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References
1. Mohammed A, Fadhil R, Mahmood MS, Al-Waeli HA. Diagnostic biomarkers for periodontitis (observ-ational case-control study). J Baghdad Coll Dent. 2024;36(2):11–9.
2. Harbood OM, Abbas RF, Hussein HM, Hamed NA, Mahmood AA, Mahmood MS. Diagnostic ability of salivary IL-6 and MMP-9 biomarkers in different stages of periodontitis (case-control study). J Emerg Med Trauma Acute Care. 2024;2024(8):1–9.
3. Hamad SA, Mahmood MS. Assessment of serum levels of monocyte chemoattractant protein 1 ( MCP 1 ) in patients with periodontitis and atherosclerotic cardiovascular disease. J Baghdad Coll Dent. 2022;34(4):9–16.
4. Zhao W, Liu C, Cui X, Chen Q. Immunological landscape of periodontitis and rheumatoid arthritis and their molecular crosstalk. Eur J Med Res. 2025;30(1):124.
5. Diehl D. Periodontitis and Systemic Health: An Interconnected Relationship. Adv Exp Med Biol. 2026;1492:83–100.
6. Koziel J, Potempa J. Pros and cons of causative association between periodontitis and rheumatoid arthritis. Periodontol 2000. 2022;89(1):83–98.
7. Kaur G, Mohindra K, Singla S. Autoimmunity—Basics and link with periodontal disease. Autoimmun Rev. 2017;16(1):64–71.
8. González-Febles J, Rodríguez-Lozano B, Sánchez-Piedra C, Garnier-Rodríguez J, Bustabad S, Hernández-González M, et al. Association between periodontitis and anti-citrullinated protein antibodies in rheumatoid arthritis patients: A cross-sectional study. Arthritis Res Ther. 2020;22(1):1–11.
9. Esfehani M, Noori A, Taghavi F, Rahmani K, Mirzadeh M, Taghavi-damghani F, et al. Evaluation of the Relationship Between the Severit y of Periodontitis and Rheumatoid Arthritis. J Inflamm Dis. 2024;27(2):1–7.
10. Dissick A, Redman RS, Jones M, Rangan B V., Reimold A, Griffiths GR, et al. Association of Periodontitis With Rheumatoid Arthritis: A Pilot Study. J Periodontol. 2010;81(2):223–30.
11. Manoil D, Courvoisier DS, Gilbert B, Möller B, Walker UA, Von Muehlenen I, et al. Associations between serum antibodies to periodontal pathogens and preclinical phases of rheumatoid arthritis. Rheumatol (United Kingdom). 2021;60(10):4755–64.
12. Krutyhołowa A, Strzelec K, Dziedzic A, Bereta GP, Łazarz-Bartyzel K, Potempa J, et al. Host and bacterial factors linking periodontitis and rheumatoid arthritis. Front Immunol. 2022;13(August):1–17.
13. Eriksson K, Nise L, Kats A, Luttropp E, Catrina AI. Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis : A Swedish Population Based Case-Control Study. 2016;1–16.
14. Gonzalez SM, Payne JB, Yu F, Thiele GM, Erickson AR, Johnson PG, et al. Alveolar Bone Loss Is Associated With Circulating Anti‐Citrullinated Protein Antibody (ACPA) in Patients With Rheumatoid Arthritis. J Periodontol. 2015;86(2):222–31.
15. Dirk Ziebolz, Annegret Rupprecht, Jan Schmickler, Laura Bothmann, Juliane Krämer, Daniel Patschan, Gerhard A. Müller, Rainer F. Mausberg, Jana Schmidt, Gerhard Schmalz SP. Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis: Results from a cross-sectional study. J Periodontol. 2018;89(11):1310–7.
16. González-Febles J, Sanz M. Periodontitis and rheumatoid arthritis: What have we learned about their connection and their treatment? Periodontol 2000. 2021;87(1):181–203.
17. Fraenkel L, Bathon JM, England BR, St.Clair EW, Arayssi T, Carandang K, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2021;73(7):1108–23.
18. Smolen JS, Landewé RBM, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2022;82(1):3–18.
19. Bywall KS, Kihlbom U, Hansson M, Falahee M, Raza K, Baecklund E. Patient preferences on rheumatoid arthritis second-line treatment : a discrete choice experiment of Swedish patients. Arthritis Res Ther. 2020;22(288):1–10.
20. Jung G un, Han J young, Hwang K gyun, Park C joo, Stathopoulou PG, Fiorellini JP. Effects of Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Response to Periodontal Treatment in Patients with Rheumatoid Arthritis. Biomed Res Int. 2018;2018(1):1465402–7.
21. Ancuța C, Chirieac R, Ancuța E, Țănculescu O, Solomon SM, Fătu AM, et al. Exploring the role of interleukin-6 receptor inhibitor tocilizumab in patients with active rheumatoid arthritis and periodontal disease. J Clin Med. 2021;10(4):1–12.
22. Kobayashi T, Ito S, Murasawa A, Ishikawa H, Tabeta K. The serum immunoglobulin G titres against Porphyromonas gingivalis as a predictor of clinical response to 1-year treatment with biological disease-modifying antirheumatic drugs in rheumatoid arthritis patients: A retrospective cohort study. Mod Rheumatol. 2023 Sep 1;33(5):918–27.
23. Kadkhoda Z, Amirzargar A, Esmaili Z, Vojdanian M. Effect of TNF- α Blockade in Gingival Crevicular Fluid on Periodontal Condition of Patients with Rheumatoid Arthritis. Iran J Immunol. 2016;13(3):197–203.
24. de Molon RS, Rossa C, Thurlings RM, Cirelli JA, Koenders MI. Linkage of periodontitis and rheumatoid arthritis: Current evidence and potential biological interactions. Vol. 20, International Journal of Molecular Sciences. 2019. 1–35 p.
25. Kaczyński T, Wroński J, Głuszko P, Kryczka T, Miskiewicz A, Górski B, et al. Salivary interleukin 6, interleukin 8, interleukin 17A, and tumour necrosis factor α levels in patients with periodontitis and rheumatoid arthritis. Cent Eur J of Immunology. 2019;44(3):269–76.
26. Bek S, Bojesen AB, Nielsen J V., Sode J, Bank S, Vogel U, et al. Systematic review and meta-Analysis: Pharmacogenetics of anti-TNF treatment response in rheumatoid arthritis. Pharmacogenomics J. 2017;17(5):403–11.
27. Coat J, Demoersman J, Beuzit S, Cornec D, Devauchelle-Pensec V, Saraux A, et al. Anti-B lymphocyte immunotherapy is associated with improvement of periodontal status in subjects with rheumatoid arthritis. J Clin Periodontol. 2015 Sep 1;42(9):817–23.
28. Kobayashi T, Ito S, Kobayashi D, Kojima A, Shimada A, Narita I, et al. Interleukin-6 receptor inhibitor tocilizumab ameliorates periodontal inflammation in patients with rheumatoid arthritis and periodontitis as well as tumor necrosis factor inhibitors. Clin Exp Dent Res. 2015;1(2):63–73.
29. Kobayashi T, Yokoyama T, Ito S, Kobayashi D, Yamagata A, Okada M, et al. Periodontal and Serum Protein Profiles in Patients With Rheumatoid Arthritis Treated With Tumor Necrosis Factor Inhibitor Adalimumab. J Periodontol. 2014;85(11):1480–8.
30. Tachibana M, Yonemoto Y, Okamura K, Suto T, Sakane H, Kaneko T, et al. Does periodontitis affect the treatment response of biologics in the treatment of rheumatoid arthritis? Arthritis Res Ther. 2020;22(1):1–7.
31. Savioli C, Ribeiro ACM, Maria ÞG, Fabri C, Calich AL, Joze Þ, et al. Persistent Periodontal Disease Hampers Anti Y Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis. J Clin Rheumatol. 2012;18(4):180–4.
32. Inchingolo F, Inchingolo AM, Avantario P, Settanni V, Fatone MC, Piras F, et al. The Effects of Periodontal Treatment on Rheumatoid Arthritis and of Anti-Rheumatic Drugs on Periodontitis: A Systematic Review. Int J Mol Sci. 2023;24(24).
33. Ibrahem DN, Mahmood MS. BIOLOGICAL THERAPY FOR PATIENTS WITH RHEUMATOID ARTHRITIS AND ITS EFFECT ON PERIODONTAL AND IMMUNOLOGICAL PARAMETERS. Biochem Cell Arch. 2021;21(1).
34. Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: A case-control study. Arthritis Res Ther. 2019;21(1):1–12.
35. Nakajima Y, Kato-Kogoe N, Yasuda T, Urakawa R, Matsuo T, Omori M, et al. Impact of Periodontal Treatment on Early Rheumatoid Arthritis and the Role of Porphyromonas gingivalis Antibody Titers. Med Sci Monit Int Med J Exp Clin Res. 2024;31.
36. Silva DS, de Vries C, Rovisco J, Serra S, Kaminska M, Mydel P, et al. The impact of periodontitis and periodontal treatment on rheumatoid arthritis outcomes: an exploratory clinical trial. Rheumatology. 2025;64(4):1679–88.
37. Thilagar S, Theyagarajan R, Mugri MH, Bahammam HA, Bahammam SA, Bahammam MA, et al. Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis. Int Dent J. 2022;72(6):832–8.
38. Botero JE, Posada-López A, Mejía-Vallejo J, Pineda-Tamayo RA, Bedoya-Giraldo E. Effects of nonsurgical periodontal therapy in patients with rheumatoid arthritis: a prospective before and after study. Colomb Med. 2021;52(3):1–13.
39. Zhou N, Zou F, Cheng X, Huang Y, Zou H, Niu Q, et al. Porphyromonas gingivalis induces periodontitis, causes immune imbalance, and promotes rheumatoid arthritis. J Leukoc Biol. 2021;110(3):461–73.
40. Cosgarea R, Tristiu R, Dumitru RB, Arweiler NB, Rednic S, Sirbu CI, et al. Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis. Clin Oral Investig. 2019;23(1):141–51.
41. Zhao X, Liu Z, Shu D, Xiong Y, He M, Xu S, et al. Association of periodontitis with rheumatoid arthritis and the effect of non-surgical periodontal treatment on disease activity in patients with rheumatoid arthritis. Med Sci Monit. 2018;24:5802–10.
42. Moura MF, Cota LOM, Silva TA, Cortelli SC, Ferreira GA, López MM, et al. Clinical and microbiological effects of non-surgical periodontal treatment in individuals with rheumatoid arthritis: a controlled clinical trial. Odontology. 2021;109(2):484–93.
43. Ding N, Luo M, Wen YH, Li RY, Bao QY. The Effects of Non-Surgical Periodontitis Therapy on the Clinical Features and Serological Parameters of Patients Suffering from Rheumatoid Arthritis as Well as Chronic Periodontitis. J Inflamm Res. 2022;15(January):177–85.
44. El-Wakeel NM, Shalaby ZF, Abdulmaguid RF, Elhamed SSA, Shaker O. Local gingival crevicular fluid, synovial fluid, and circulating levels of prolactin hormone in patients with moderately active rheumatoid arthritis and stage III and IV periodontitis before and after non-surgical periodontal treatment—a controlled trial. Clin Oral Investig. 2023;27(6):2813–21.
45. Yuce HB, Gokturk O, Turkal HA, Inanir A, Benli I, Demir O. Assessment of local and systemic 25-hydroxy-vitamin D, RANKL, OPG, and TNF levels in patients with rheumatoid arthritis and periodontitis. J Oral Sci. 2017;59(3):397–404.
46. Anusha D, Chaly PE, Junaid M, Nijesh JE, Shivashankar K, Sivasamy S. Efficacy of a Mouthwash Containing Essential oils and Curcumin as an Adjunct to Nonsurgical Periodontal Therapy among Rheumatoid Arthritis Patients with Chronic Periodontitis: A Randomized Controlled Trial. Indian J Dent Res. 2019;30(4).
47. Elsadek MF, Farahat MF. Impact of photodynamic therapy as an adjunct to non-surgical periodontal treatment on clinical and biochemical parameters among patients having mild rheumatoid arthritis with periodontitis. Photodiagnosis Photodyn Ther. 2022;37(December 2021).
48. Huang J, Zeng T, Zhang X, Tian Y, Wu Y, Yu J, et al. Clinical diagnostic significance of 14-3-3η protein, high-mobility group box-1, anti-cyclic citrullinated peptide antibodies, anti-mutated citrullinated vimentin antibodies and rheumatoid factor in rheumatoid arthritis. Br J Biomed Sci. 2020;77(1):19–23.
49. Kondo N, Kuroda T, Kobayashi D. Cytokine networks in the pathogenesis of rheumatoid arthritis. Int J Mol Sci. 2021;22(20).
50. Nesse W, Westra J, van der Wal JE, Abbas F, Nicholas AP, Vissink A, et al. The periodontium of periodontitis patients contains citrullinated proteins which may play a role in ACPA (anti-citrullinated protein antibody) formation. J Clin Periodontol. 2012 Jul 1;39(7):599–607.
51. Yamashita M, Kobayashi T, Ito S, Kaneko C, Murasawa A, Ishikawa H, et al. The periodontal inflamed surface area is associated with the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a retrospective study. Mod Rheumatol. 2020 Nov 1;30(6):990–6.