Effects of different immunosuppressive drugs on the periodontal status and changes in periodontal pathogenic bacterial flora in rheumatoid arthritis patients

Purpose: To investigate the prevalence of periodontal disease(s) and the associated bacteria among rheumatoid arthritis (RA) patients treated with different immunosuppressive drugs. Methods: Patients aged 18 - 65 years who had a 6-month history of RA, and were diagnosed as per the American College of Rheumatology and European League against Rheumatism, were included in the study. Supragingival plaque was removed by dentists. Using sterile paper strips, sub-gingival biofilm samples were collected from 5 of the deepest periodontal pockets. The samples were sent to pathologists for assessment. Polymerase chain reaction was carried out on them. Detection thresholds were >10(2) for Aggregatibacter actinomycetemcomitans, while the detection threshold for Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenellacorrodens, and Capnocytophaga species was 10(3). Results: There was a higher number of patients with bleeding-on-probing amongst cohorts who received a combination of methotrexate and tumor necrosis factor-a antagonist than in those given leflunomide only (52 vs. 29, p = 0.041, q = 3.064), or methotrexate + rituximab (52 vs. 30, p = 0.041, q = 3.131, Fig. 1). Papilla bleeding index was lowest in patients who were treated with leflunomide. Almost all patients had dental infection with Fusobacterium nucleatum. Conclusion: These results indicate that treatment of RA with methotrexate results in periodontal inflammation.