{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:54:54Z","timestamp":1784040894808,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Periodontitis, a bacterial-induced infection of the supporting soft and hard tissues of the teeth (the periodontium), is common in patients with rheumatoid arthritis (RA). As RA and periodontitis underlie common inflammatory pathways, targeting the progression of RA might mediate both periodontitis and RA. On the other hand, patients with RA on immunosuppressive medication have an increased risk of infection. Therefore, the objective of this longitudinal observation study was to assess the effect of methotrexate (MTX) and anti-tumor necrosis factor-\u03b1 (anti-TNF, etanercept) treatment on the periodontal condition of RA patients. Overall, 14 dentate treatment-naive RA patients starting with MTX and 12 dentate RA patients starting with anti-TNF therapy in addition to MTX were included. Follow-up was scheduled matching the routine protocol for the respective treatments. Prior to the anti-rheumatic treatment with MTX or the anti-TNF therapy in addition to MTX, and during follow-up, i.e., 2 months for MTX, and 3 and 6 months for the anti-TNF therapy in addition to MTX, the periodontal inflamed surface area (PISA) was measured. The efficacy of the anti-rheumatic treatment was assessed by determining the change in RA disease activity (DAS28-ESR). Furthermore, the erythrocyte sedimentation rates were determined and the levels of C-reactive protein, IgM-rheumatoid factor, anti-cyclic citrullinated protein antibodies, and antibodies to the periodontal pathogen Porphyromonas gingivalis, were measured. Subgingival sampling and microbiological characterization of the subgingival microflora was done at baseline. MTX or anti-TNF treatment did not result in an improvement of the periodontal condition, while both treatments significantly improved DAS28 scores (both p &lt; 0.01), and reduced C-reactive protein levels and erythrocyte sedimentation rates (both p &lt; 0.05). It is concluded that anti-rheumatic treatment (MTX and anti-TNF) has negligible influence on the periodontal condition of RA patients.<\/jats:p>","DOI":"10.3390\/ijerph18052529","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T21:58:07Z","timestamp":1614895087000},"page":"2529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Effect of Anti-Rheumatic Treatment on the Periodontal Condition of Rheumatoid Arthritis Patients"],"prefix":"10.3390","volume":"18","author":[{"given":"Menke J.","family":"de Smit","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands"},{"name":"Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands"},{"name":"Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6581-6508","authenticated-orcid":false,"given":"Johanna","family":"Westra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel D.","family":"Posthumus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Springer","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie Jan","family":"van Winkelhoff","sequence":"additional","affiliation":[{"name":"Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2581-4361","authenticated-orcid":false,"given":"Arjan","family":"Vissink","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Bijl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/prd.12296","article-title":"The role of the microbiota in periodontal disease","volume":"83","author":"Curtis","year":"2020","journal-title":"Periodontology 2000"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/prd.12344","article-title":"Clinical and public health implications of periodontal and systemic diseases: An overview","volume":"83","author":"Genco","year":"2020","journal-title":"Periodontol 2000"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.jbspin.2020.04.024","article-title":"Rheumatoid arthritis risk in periodontitis patients: A systematic review and meta-analysis","volume":"87","author":"Qiao","year":"2020","journal-title":"Jt. Bone Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1001\/jama.2018.13103","article-title":"Diagnosis and Management of Rheumatoid Arthritis: A Review","volume":"320","author":"Aletaha","year":"2018","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"R222","DOI":"10.1186\/ar4061","article-title":"Periodontitis in established rheumatoid arthritis patients: A cross-sectional clinical, microbiological and serological study","volume":"14","author":"Westra","year":"2012","journal-title":"Arthritis Res. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Renvert, S., Berglund, J.S., Persson, G.R., and S\u00f6derlin, M.K. (2020). The association between rheumatoid arthritis and periodontal disease in a population-based cross-sectional case-control study. BMC. Rheumatol., 4.","DOI":"10.1186\/s41927-020-00129-4"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3389\/fimmu.2016.00080","article-title":"Hand to Mouth: A Systematic Review and Meta-Analysis of the Association between Rheumatoid Arthritis and Periodontitis","volume":"7","author":"Fuggle","year":"2016","journal-title":"Front. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s13075-020-02269-x","article-title":"Does periodontitis affect the treatment response of biologics in the treatment of rheumatoid arthritis?","volume":"22","author":"Tachibana","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1038\/nm939","article-title":"Lasker Clinical Medical Research Award. TNF defined as a therapeutic target for rheumatoid arthritis and other autoimmune diseases","volume":"9","author":"Feldmann","year":"2003","journal-title":"Nat Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/14740338.2016.1240783","article-title":"Risk of infections using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: A systematic review and meta-analysis","volume":"15","author":"Minozzi","year":"2016","journal-title":"Expert. Opin. Drug. Saf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s10266-020-00517-9","article-title":"Association of cytokine patterns and clinical\/laboratory parameters, medication and periodontal burden in patients with rheumatoid arthritis (RA)","volume":"108","author":"Patschan","year":"2020","journal-title":"Odontology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/s41368-019-0068-8","article-title":"Interleukin-1\u03b2 is a potential therapeutic target for periodontitis: A narrative review","volume":"12","author":"Cheng","year":"2020","journal-title":"Int. J. Oral. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"591365","DOI":"10.3389\/fimmu.2020.591365","article-title":"Use of TNF inhibitors in rheumatoid arthritis and implications for the periodontal status: For the benefit of both?","volume":"11","author":"Zamri","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1002\/JPER.17-0616","article-title":"Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis: Results from a cross-sectional study","volume":"89","author":"Ziebolz","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_15","first-page":"139","article-title":"Is the treatment with biological or non-biological DMARDS a modifier of periodontal condition in patients with rheumatoid arthritis?","volume":"13","author":"Mesa","year":"2017","journal-title":"Curr. Rheumatol. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1111\/j.1600-051X.2008.01249.x","article-title":"Periodontal inflamed surface area: Quantifying inflammatory burden","volume":"35","author":"Nesse","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1136\/annrheumdis-2012-201426","article-title":"The 2010 ACR\/EULAR criteria for rheumatoid arthritis: Do they affect the classification or diagnosis of rheumatoid arthritis?","volume":"71","author":"Huizinga","year":"2012","journal-title":"Ann. Rheum. Dis."},{"key":"ref_18","first-page":"S85","article-title":"Evidence that periodontal treatment improves biomarkers and CVD outcomes","volume":"40","author":"Orlandi","year":"2013","journal-title":"J. Clin. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1080\/00016357.2017.1401659","article-title":"Periodontal inflamed surface area and periodontal case definition classification","volume":"76","author":"Leira","year":"2018","journal-title":"Acta Odontol. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3109\/03009749509099303","article-title":"IgM, IgA, and IgG Rheumatoid Factors in Early Rheumatoid Arthritis Predictive of Radiological Progression?","volume":"24","author":"Westra","year":"1995","journal-title":"Scand. J. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1038\/nrrheum.2010.139","article-title":"Periodontitis in RA-the citrullinated enolase connection","volume":"6","author":"Lundberg","year":"2010","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1902\/jop.2009.080447","article-title":"Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors","volume":"80","author":"Ortiz","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e011916","DOI":"10.1136\/bmjopen-2016-011916","article-title":"Periodontitis in early and chronic rheumatoid arthritis: A prospective follow-up study in Finnish population","volume":"7","author":"Kuuliala","year":"2017","journal-title":"BMJ Open"},{"key":"ref_24","first-page":"180","article-title":"Persistent periodontal disease hampers anti-tumor necrosis factor treatment response in rheumatoid arthritis","volume":"18","author":"Savioli","year":"2012","journal-title":"J. Clin. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1902\/jop.2014.140194","article-title":"Periodontal and serum protein profiles in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitor adalimumab","volume":"85","author":"Kobayashi","year":"2014","journal-title":"J Periodontol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1902\/jop.2012.120009","article-title":"Periodontal Condition of Patients with Autoimmune Diseases and the Effect of Anti-Tumor Necrosis Factor-\u03b1 Therapy","volume":"84","author":"Mayer","year":"2013","journal-title":"J. Periodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s10753-013-9652-9","article-title":"Host Modulation in Rheumatoid Arthritis Patients with TNF Blockers Significantly Decreases Biochemical Parameters in Periodontitis","volume":"36","author":"Erciyas","year":"2013","journal-title":"Inflammation"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lakio, L., Antinheimo, J., Paju, S., Buhlin, K., Pussinen, P.J., and Alfthan, G. (2009). Tracking of plasma antibodies against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis during 15 years. J. Oral Microbiol., 1.","DOI":"10.3402\/jom.v1i0.1979"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1111\/odi.13145","article-title":"Cytokines in gingivocrevicular fluid of rheumatoid arthritis patients: A review of the literature","volume":"25","author":"Rahajoe","year":"2019","journal-title":"Oral. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/prd.12249","article-title":"A review of the influence of periodontal treatment in systemic diseases","volume":"79","author":"Falcao","year":"2019","journal-title":"Periodontology 2000"},{"key":"ref_31","first-page":"424","article-title":"Changes in anti-cyclic citrullinated peptide antibodies and rheumatoid factor isotypes serum levels in patients with rheumatoid arthritis following treatment with different biological drugs","volume":"34","author":"Iannone","year":"2017","journal-title":"Clin. Exp. Rheumatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:32:27Z","timestamp":1760160747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["ijerph18052529"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18052529","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,4]]}}}