Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

The aim of the present study was to provide an overview evaluating the effects of non-surgical periodontal treatment in rheumatoid arthritis, focusing on 28-joint Disease Activity Score (DAS28), C-reactive protein, and erythrocyte sedimentation rate. Systematic reviews, with and without meta-analyses, comparing individuals who had undergone non-surgical periodontal treatment with those who had not, and assessing parameters before and after treatment, were included. Electronic searches were conducted in August 2023 and updated in August 2024 across four databases (PubMed, Scopus, Embase, and Web of Science) and gray literature, with no restriction on language or publication date. The study followed the 2020 PRISMA statement, and a protocol was registered in PROSPERO (CRD42023414714). A total of 10 systematic reviews were included: six with meta-analyses and four without meta-analyses. The number of articles included ranged from three to 31 studies. Non-surgical periodontal treatment resulted in a significant decrease in C-reactive protein, erythrocyte sedimentation rate, and DAS28. The follow-up period after treatment ranged from six to 24 weeks. A meta-analysis was conducted, incorporating data from 18 primary studies identified in the systematic reviews and comparing the difference in DAS28 at baseline (n = 454) and up to three months (n = 449) after the non-surgical periodontal treatment. A significant reduction in DAS28 was observed (MD = - 0.76; 95% CI = - 1.07 to - 0.44). Despite the heterogeneity of data related to rheumatoid arthritis and periodontitis status, non-surgical periodontal treatment can result in a decrease in the concentration of circulating inflammatory mediators and, consequently, in a reduction in DAS28 in rheumatoid arthritis.