References (Periodontal Disease and Rheumatoid Arthritis: Interconnections and Clinical Implications)

Delnay, N., McNinch, N., Toth, M. Pathogens in the inflammatory process of periodontal disease and juvenile idiopathic arthritis. Arthritis Rheumatol. 69 (2017).
Children with CCP-positive or RF-positive juvenile idiopathic arthritis (JIA) have similar bacterial profiles as children with periodontal disease, placing them at risk for periodontal disease development. This highlights the importance of including oral health exams in the management of JIA.

Monsarrat, P., Fernandez de Grado, G., Constantin, A., Willmann, C., Nabet, C., Sixou, M., Cantagrel, A., Barnetche, T., Mehsen-Cetre, N., Schaeverbeke, T., Arrivé, E., Vergnes, J.-N. The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial. Joint Bone Spine. 86 (2019).
Periodontal treatment improved oral inflammation and was safe in rheumatoid arthritis (RA) patients but did not significantly alter RA disease activity or general quality of life.

Patschan, S., Bothmann, L., Patschan, D., Henze, E., Schmalz, G., Ritter, O., Ziebolz, D. Association of cytokine patterns and clinical/laboratory parameters, medication and periodontal burden in patients with rheumatoid arthritis (RA). Odontology. 108 (2020).
RA patients with periodontal disease exhibit altered serum cytokine levels (IL-6, IL-10, IL-17, IL-23) related to disease activity and medications, highlighting complex interactions between RA and periodontal burden.

Äyräväinen, L., Heikkinen, A., Meurman, J. Impact of Oral Health on Rheumatoid Arthritis. Med. Res. Arch. 11 (2023).
Oral infections, including periodontitis, contribute to systemic inflammation and autoantibody generation in RA. Impaired manual dexterity in RA patients necessitates personalized oral hygiene guidance.

Aloyouny, A.Y., Almufarji, F., Almutairi, G.G., Alkait, S., Al-Mohaya, M.A., Alserwi, R. Impact of Rheumatic Diseases on Oral Health-Related Quality of Life. Cureus (2022).
Rheumatic diseases, especially RA and SLE, reduce oral health-related quality of life (OHRQoL), with high prevalence of dental caries and periodontal disease affecting daily life.

Silva, D.S., Costa, F., Baptista, I.P., Santiago, T., Lund, H., Tarp, S., daSilva, J.A.P., Christensen, R. Evidence-Based Research on Effectiveness of Periodontal Treatment in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Arthritis Care Res. 74 (2022).
Periodontal therapy in RA patients shows potential to reduce disease activity, although evidence is limited and heterogeneous, emphasizing the need for rigorous trials.

Bagavant, H., Dunkleberger, M.L., Wolska, N., Sroka, M., Rasmussen, A., Adrianto, I., Montgomery, C., Sivils, K., Guthridge, J.M., James, J.A., Merrill, J.T., Deshmukh, U.S. Antibodies to periodontogenic bacteria are associated with higher disease activity in lupus patients. Clin. Exp. Rheumatol. 37 (2019).
Exposure to specific periodontal bacteria, particularly A. actinomycetemcomitans, correlates with higher disease activity in SLE, supporting periodontal care as an adjunct to systemic therapy.

Isola, G., Williams, R.C., Lo Gullo, A., Ramaglia, L., Matarese, M., Iorio-Siciliano, V., Cosio, C., Matarese, G. Risk association between scleroderma disease characteristics, periodontitis, and tooth loss. Clin. Rheumatol. 36 (2017).
Patients with systemic sclerosis (SSc) have higher odds of periodontal disease and tooth loss, correlated with disease duration and severity, underlining the need for dental monitoring.

Manzano, B.R., Santos, P.S. da S., Bariquelo, M.H., Merlini, N.R.G., Honório, H.M., Rubira, C.M.F. A case-control study of oral diseases and quality of life in individuals with rheumatoid arthritis and systemic lupus erythematosus. Clin. Oral Investig. 25 (2021).
RA and SLE patients have higher prevalence of periodontal disease, xerostomia, and caries, leading to compromised oral and general quality of life.

Rajkarnikar, J., Thomas, B. S., Rao, S. K. Inter-relationship between rheumatoid arthritis and periodontitis. Kathmandu Univ. Med. J. 11, 41 (2013).
A significant association was observed between rheumatoid arthritis and periodontitis. RA patients exhibited higher gingival index, greater alveolar bone loss, and elevated ESR and CRP levels, suggesting a common underlying inflammatory dysregulation.

Zhang, Suhan, Zhu, Junfei, Zhu, Yanshan, Zhang, Xiaochao, Wu, Ruifang, Li, Siying, Su, Yuwen. Oral manifestations of patients with systemic sclerosis: a meta-analysis for case-controlled studies. BMC Oral Health 21, 1 (2021).
Systemic sclerosis patients showed limited mouth opening, higher prevalence of periodontitis, worse periodontal status, and more decayed teeth, highlighting the need for routine oral hygiene and early periodontal intervention.

Tamagno, Gabriela Spanholi, Nassar, Carlos Augusto, Nogueira, Marcio Augusto, Monteiro, Myllenah Marrahyllah Simão, Nassar, Patrícia Oehlmeyer. Influence of periodontal treatment on rheumatoid arthritis clinical parameters. Cuad. Educ. Desarro. 16, 2 (2024).
Periodontal treatment in RA patients led to improvements in clinical measures (T, DAS28, VAS), indicating that periodontal health can influence systemic disease activity.

Huang, Jia Lun, Chen, Wei Kung, Lin, Cheng Li, Lai, Ching Yuan, Kao, Chia Hung, Chiang, Hsien Hsiung, Yang, Tse Yen, Shih, Hong Mo. Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage—a nationwide, population-based cohort study. Medicine (United States) 98, 10 (2019).
Intensive periodontal treatment reduced the risk of spontaneous intracerebral hemorrhage, particularly in elderly males and patients receiving multiple treatments, suggesting a protective systemic effect of periodontal care.

Baron, Murray, Hudson, Marie, Tatibouet, Solène, Steele, Russell, Lo, Ernest, Gravel, Sabrina, Gyger, Geneviève, Sayegh, Tarek El, Pope, Janet, et al. The Canadian systemic sclerosis oral health study: Orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population. Rheumatology (United Kingdom) 53, 8 (2014).
Patients with systemic sclerosis had more decayed teeth, periodontal disease, lower saliva production, smaller interincisal distance, and reduced oral health-related quality of life compared to healthy controls, emphasizing the importance of targeted oral interventions.

Monsarrat, Paul, Vergnes, Jean Noël, Cantagrel, Alain, Algans, Nadège, Cousty, Sarah, Kémoun, Philippe, Bertrand, Caroline, Arrivé, Elise, et al. Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis: Study protocol of the randomized, controlled ESPERA trial. Trials 14, 1 (2013).
This randomized controlled trial protocol aimed to assess whether non-surgical periodontal treatment could improve RA clinical outcomes, disease activity, and quality of life, highlighting the potential role of oral care in systemic disease management.

El-Shinnawi, Una, Soory, Mena. Associations between Periodontitis and Systemic Inflammatory Diseases: Response to Treatment. Recent Pat. Endocr. Metab. Immune Drug Discov. 7, 3 (2013).
Periodontitis contributes to systemic inflammation, affecting conditions such as RA, coronary heart disease, and insulin resistance. Effective periodontal treatment may reduce systemic inflammatory burden, although genetic and other individual factors influence outcomes.

Äyräväinen, Leena, Heikkinen, Anna Maria, Kuuliala, Antti, Ahola, Kirsi, Koivuniemi, Riitta, Laasonen, Leena, Moilanen, Eeva, Hämäläinen, Mari, Tervahartiala, Taina, et al. Inflammatory biomarkers in saliva and serum of patients with rheumatoid arthritis with respect to periodontal status. Ann. Med. 50, 4 (2018).
Early RA patients had elevated salivary MMP-8 and IL-6 reflecting periodontal inflammation, while chronic RA patients had elevated serum biomarkers indicating systemic inflammation, showing the interplay between oral and systemic disease.

Scher, Jose U., Bretz, Walter A., Abramson, Steven B. Periodontal disease and subgingival microbiota as contributors for rheumatoid arthritis pathogenesis: Modifiable risk factors? Curr. Opin. Rheumatol. 26, 4 (2014).
Periodontal disease, smoking, and alterations in oral microbiota, particularly Porphyromonas gingivalis, may contribute to RA pathogenesis, suggesting modifiable risk factors that could be targeted for prevention and adjunct therapy.

Martu, Maria Alexandra, Maftei, George Alexandru, Luchian, Ionut, Stefanescu, Ovidiu Mihail, Scutariu, Mihaela Monica, Solomon, Sorina Mihaela. The effect of acknowledged and novel anti-rheumatic therapies on periodontal tissues—A narrative review. Pharmaceuticals 14, 12 (2021).
RA and PD share multiple genetic and environmental risk factors and involve immune–inflammatory dysregulation. Anti-rheumatic therapies, including NSAIDs, glucocorticoids, DMARDs, and emerging interventions (e.g., MMP inhibitors, TLR blockers, pro-resolution mediators, stem cell therapy), may influence periodontal tissues, though precise effects remain under investigation. Patient stratification and periodontal monitoring could optimize RA outcomes.

Johannsen, Annsofi, Susin, Cristiano, Gustafsson, Anders. Smoking and inflammation: Evidence for a synergistic role in chronic disease. Periodontology 2000 64, 1 (2014).
Tobacco smoking is a major preventable risk factor for periodontitis and exacerbates systemic inflammatory diseases including RA. Smoking alters leukocyte chemotaxis, antibody production, and pro-inflammatory mediator release, supporting the notion that periodontitis represents a hyperinflammatory condition influenced by environmental and genetic factors.

Fabri, Gisele M. C., Savioli, Cynthia, Siqueira, José T., Campos, Lucia M., Bonfá, Eloisa, Silva, Clovis A. Periodontal disease in pediatric rheumatic diseases. Revista Brasileira de Reumatologia 54, 4 (2014).
Gingivitis is prevalent among pediatric rheumatic diseases (PRD) including JIA, C-SLE, and JDM, whereas periodontitis is rare. Disease activity, drug therapy (corticosteroids, cyclosporine), diet, and functional disability influence periodontal manifestations. Gingival inflammation correlates with systemic autoimmune activity, warranting further study of periodontal resolution on PRD outcomes.

Kiernan, Yvonne, O’Connor, Cathal, Ryan, John, Murphy, Michelle. Oral health in patients with severe inflammatory dermatologic and rheumatologic disease. Skin Health and Disease 3, 1 (2023).
Patients with chronic inflammatory dermatologic/rheumatologic conditions exhibit worse oral health and quality of life, including increased periodontitis, tooth loss, and xerostomia. Systemic or biologic therapies can further impair oral health. Routine oral health assessments and multidisciplinary care are recommended for optimal management.

Eriksson, Kaja, Fei, Guozhong, Lundmark, Anna, Benchimol, Daniel, Lee, Linkiat, Hu, Yue O. O., Kats, Anna, Saevarsdottir, Saedis, Catrina, Anca Irinel, Klinge, Björn, Andersson, Anders F., Klareskog, Lars, Lundberg, Karin, Jansson, Leif, Yucel-Lindberg, Tülay. Periodontal health and oral microbiota in patients with rheumatoid arthritis. Journal of Clinical Medicine 8, 5 (2019).
Most RA patients present with moderate to severe periodontitis, which is associated with ACPA positivity, altered subgingival microbiota, and elevated systemic and local inflammatory mediators. Findings support a bidirectional link between RA activity and periodontal disease severity.

Davison, Emily, Johnston, William, Piela, Krystyna, Rosier, Bob T., Paterson, Michael, Mira, Alex, Culshaw, Shauna. The subgingival plaque microbiome, systemic antibodies against bacteria and citrullinated proteins following periodontal therapy. Pathogens 10, 2 (2021).
Non-surgical periodontal therapy reduces oral inflammation and anti-P. gingivalis IgG, though systemic inflammatory markers remain largely unchanged. P. gingivalis colonization correlates with higher anti-citrullinated protein antibody (ACPA) levels, suggesting a microbiota-driven link between periodontitis and RA.

Georgiou, T. O., Marshall, R. I., Bartold, P. M. Prevalence of systemic diseases in Brisbane general and periodontal practice patients. Australian Dental Journal 49, 4 (2004).
Patients with periodontitis show higher prevalence of systemic diseases, including bronchitis, hepatitis, and RA, compared to general dental patients. Public clinic attendees exhibited more systemic comorbidities than private patients, highlighting the intersection of periodontal and systemic health.

Corrêa, Jôice Dias, Fernandes, Gabriel R., Calderaro, Débora Cerqueira, Mendonça, Santuza Maria Souza, Silva, Janine Mayra, Albiero, Mayra Laino, Cunha, Fernando Q., Xiao, E., Ferreira, Gilda Aparecida, Teixeira, Antônio Lúcio, Mukherjee, Chiranjit, Leys, Eugene J., Silva, Tarcília Aparecida, Graves, Dana T. Oral microbial dysbiosis linked to worsened periodontal condition in rheumatoid arthritis patients. Scientific Reports 9, 1 (2019).
RA patients exhibit higher bacterial load, increased microbial diversity, and elevated inflammatory mediators. Oral dysbiosis correlates with RA severity, underscoring the importance of monitoring periodontal health in systemic autoimmune conditions.

Monsarrat, Paul, Grado, Gabriel Fernandez de, Constantin, Arnaud, Willmann, Claire, Nabet, Cathy, Sixou, Michel, Cantagrel, Alain, Barnetche, Thomas, Mehsen-Cetre, Nadia, Schaeverbeke, Thierry, Arrivé, Elise, Vergnes, Jean Noel. The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial. Joint Bone Spine 86, 5 (2019).
Non-surgical periodontal therapy improves oral inflammation in RA patients but does not significantly alter RA activity or general quality of life. Results highlight the value of integrated periodontal care in RA management.

Hascoët, Emilie, Blanchard, Frédéric, Blin-Wakkach, Claudine, Guicheux, Jérôme, Lesclous, Philippe, Cloitre, Alexandra. New insights into inflammatory osteoclast precursors as therapeutic targets for rheumatoid arthritis and periodontitis. Bone Research 11, 1 (2023).
RA and periodontitis share immunopathogenic mechanisms leading to inflammatory bone resorption. Distinct inflammatory osteoclast precursors contribute to disease progression, providing potential therapeutic targets to mitigate bone loss.

Posada-López, Adriana, Botero, Javier Enrique, Pineda-tamayo, Ricardo Antonio, Agudelo-Suárez, Andrés A. The effect of periodontal treatment on clinical and biological indicators, quality of life, and oral health in rheumatoid arthritis patients: A quasi-experimental study. International Journal of Environmental Research and Public Health 19, 3 (2022).
Non-surgical periodontal therapy improved psychological well-being and oral health-related quality of life in RA patients, despite minimal changes in disease activity scores (DAS-28). Findings emphasize periodontal care as a component of holistic RA management.

Kocaman, Gülhan. Awareness on the effects of periodontal diseases on the general health of individuals with systemic diseases and determination of influential factors. Meandros Medical and Dental Journal 21, 1 (2020).
Awareness of periodontal–systemic disease interactions is low. Education, oral hygiene training, and regular dental care positively influence disease outcomes and quality of life.