Assessing the efficacy of nonsurgical periodontal treatment on rheumatoid arthritis: an umbrella review.

Abstract

Objective: The relationship between periodontitis and rheumatoid arthritis has attracted considerable interest. However, the effect of nonsurgical periodontal treatment (NSPT) on rheumatoid arthritis remains uncertain. This umbrella review aims to consolidate current research to establish a stronger evidence base.

Method and materials: Medline, Embase, and the Cochrane library were searched from inception to August 2024. Two independent reviewers handled study selection, data extraction, and quality assessment (AMSTAR 2). The qualitative analysis covered clinical activity, joint symptoms, inflammatory markers, cytokines, and autoantibodies. Quantitative results for disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were reported as mean differences with 95% confidence intervals (CIs).

Results: A total of 2,982 records were screened, with 41 full-text articles assessed for eligibility, and 9 selected for evidence synthesis. Qualitative analysis suggests that NSPT may reduce clinical activity in patients with periodontitis and rheumatoid arthritis. Quantitative analysis provided suggestive evidence on the effects of NSPT on DAS28, with the mean difference ranging from -0.38 (95% CI -0.46 to -0.31) to -1.18 (95% CI -1.43 to -0.93). One-third of the included studies were rated as 'high' quality, while another one-third were 'critically low.'

Conclusions: The present evidence suggests that NSPT may provide benefits in managing rheumatoid arthritis symptoms in patients with periodontitis; however, the potential bias of current evidence calls for further rigorous studies. Clinicians should account for the complex interplay between periodontitis and rheumatoid arthritis when devising treatment strategies.