TNF Inhibitors and Periodontal Inflammation in Psoriatic Arthritis

The link between immune mediated rheumatic disorders and oral health, particularly periodontal disease, is widely accepted, based on shared immune and inflammatory processes as well as local (articular, gingival) damage mediated by similar pro-inflammatory cytokine and destructive mediators. We aimed to evaluate periodontal status in psoriatic arthritis (PsA) before and after 24-weeks treatment with TNF inhibitors and to identify potential relation between disease activity, inflammatory parameters, therapeutic response and chronic periodontitis. Patients were prospectively assessed according to a standard protocol comprising a complex rheumatologic (PsA activity, inflammatory prolife) and dental evaluation (plaque and gingival index, bleeding on probing, periodontal pocket depth, clinical attachment level). Up to one third PsA presented with moderate to severe periodontitis at baseline, with high prevalence of sites with dental plaque, abnormal bleeding, increased periodontal pocket depth and clinical attachment loss. Higher levels of inflammatory parameters were described in the subset of PsA presenting with aggressive periodontal diseases, while significant correlation between dental pathology and CRP (p[0.05). A significant improvement in both PsA-related parameters and periodontal status was demonstrated after 24 weeks of anti-TNF therapy (p[0.05). Periodontal disease may develop in PsA and should be commonly evaluated, particularly patients with active disease. Benefits of TNF inhibitors, with significant response in articular and periodontal parameters, suggest common inflammatory pathways in both entities.