Six-month follow-up of periodontal condition and oral mucosa lesions in arthritis patients undergoing anti-tumour necrosis factor-α therapy

Abstract Introduction: Peridontitis has been associated with inflammatory rheumatic diseases. Objectives: We evaluated oral mucosal, periodontal, and periapical dental condition of 24 arthritis patients at baseline and after six months of biological therapy and we also determined if their baseline dental condition would affect the outcome of biological therapy. Methods: The mean age of these patients was 48.8±13.8 years and their mean disease duration was 7.81±7.29 years. Clinical responder (R) and non-responder (NR) status was determined after 6 months of anti-TNF treatment. Altogether 20 patients (9 RA and 11 AS) started on 50 mg etanercept (ETN) SC weekly, while 4 patients (all RA) received certolizumab pegol (CZP; 400 mg at 0, 2 and 4 weeks and thereafter 200 mg every two weeks SC). Results: During the six months of treatment period, 6 patients (3 female RA and 3 male AS) terminated the study prematurely as they did not respond to treatment (NR). By the end of study period, oral lichen planus (OLP) lesions developed on the oral mucosa of two patients (1 male and 1 female). When comparing periodontal indices at baseline and after 6 months of anti-TNF treatment in R group, GI increased (0.65±0.34 vs 0.88±0.30; p<0.05), while CPD max (4±1.94 vs 2.72±1.36; p<0.05) and CAL max decreased (5.22±2.56 vs 2.72±1.36; p<0.05) over time. Therapeutic success was associated with older age (R: 52.7±11.8 years; NR: 37.2±13.4 years; p<0.05). In addition, there was a significant difference in mean baseline GI in R (0.65±0.39) and NR patients (0.52±0.07; p<0.05). Conclusions: We postulate that younger age and mild gingival inflammation in such patients may result in anti-TNF therapy failure. Certainly, further studies are needed to elucidate this issue.