Non-Cochrane · intervention · PM42452559
The Impact of Periodontal Therapy on Disease Activity in Patients with Rheumatoid Arthritis and Concomitant Periodontitis: A Systematic Review and Meta-Analysis.
Khennoufa Lina, Vinhas Ana Sofia, Benoit Josselin, et al. · Journal of clinical medicine · 2026 · PubMed · doi:10.3390/jcm15135099
Findings
23 findings
| Population | ||||
|---|---|---|---|---|
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR (change or follow-up not specified) 3 months · Sensitivity: excluding trials with adjunctive systemic antimicrobials (analysis type not specified in text) | MD -1.14 [-1.51, -0.78] GRADE not reported 3 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 3 months · Sensitivity: excluding Nakajima 2025 | MD -0.51 [-0.90, -0.13] GRADE not reported 3 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 3 months · Sensitivity: Hartung-Knapp adjustment | MD -0.55 [-0.90, -0.21] GRADE not reported 4 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Steps 1 and 2 of periodontal therapy (supragingival PMPR and subgingival instrumentation, with or without OHI) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR, change from baseline 6 months · Overall | no estimate extracted No studies found 0 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 6 months · Exploratory combination of 2 trials, pre/post correlation r = 0 (not pooled by the authors) | MD -0.58 [-1.18, 0.03] GRADE not reported 2 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 3 months · Sensitivity: excluding trials at high risk of bias | MD -0.48 [-0.88, -0.07] GRADE not reported 2 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, follow-up value 3 months · Sensitivity: excluding trials at high risk of bias | MD -0.58 [-1.09, -0.07] GRADE not reported 2 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 6 months · Exploratory combination of 2 trials, pre/post correlation r = 0.7 (not pooled by the authors) | MD -0.57 [-0.91, -0.23] GRADE not reported 2 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 3 months | MD -0.55 [-0.92, -0.19] Low Downgraded: risk of bias, imprecision 4 studies · 189 participants |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, follow-up value 3 months · Sensitivity: Hartung-Knapp adjustment | MD -0.84 [-1.77, 0.09] GRADE not reported 4 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, change from baseline 6 months · Exploratory combination of 2 trials, pre/post correlation r = 0.5 (not pooled by the authors) | MD -0.57 [-1.01, -0.14] GRADE not reported 2 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR, follow-up value 3 months · Sensitivity: Hartung-Knapp adjustment | MD -0.89 [-2.23, 0.45] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR, change from baseline 3 months | MD -1.27 [-2.22, -0.31] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 211 participants |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR, change from baseline 3 months · Sensitivity: Hartung-Knapp adjustment | MD -1.27 [-2.54, 0.01] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, follow-up value 3 months · Sensitivity: excluding Nakajima 2025 | MD -0.83 [-1.50, -0.15] GRADE not reported 3 studies |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-CRP, follow-up value 3 months | MD -0.84 [-1.38, -0.29] Low Downgraded: risk of bias, imprecision 4 studies · 189 participants |
| Adults with rheumatoid arthritis and concomitant periodontitis | Periodontal therapy steps 1-2 (supragingival PMPR and subgingival instrumentation) | No periodontal treatment, delayed treatment, or oral hygiene instructions alone | DAS28-ESR, follow-up value 3 months | MD -0.89 [-1.85, 0.07] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 211 participants |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in DAS28 vs Change in CAL 3 months · Exploratory study-level correlation | Pearson r 0.033 [-0.875, 0.889] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in PPD vs Change in CAL 3 months · Exploratory study-level correlation | Spearman rho 0.900 [-0.169, 0.996] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in DAS28 vs Change in PPD 3 months · Exploratory study-level correlation | Pearson r 0.127 [-0.850, 0.908] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in PPD vs Change in CAL 3 months · Exploratory study-level correlation | Pearson r 0.956 [0.470, 0.997] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in DAS28 vs Change in PPD 3 months · Exploratory study-level correlation | Spearman rho 0.200 [-0.833, 0.922] GRADE not reported 5 studies |
| Adults with rheumatoid arthritis and periodontitis in five RCTs reporting PPD and CAL as mean and SD | Study-level change in periodontal parameters after periodontal therapy (exploratory dose-response) | Not applicable | Change in DAS28 vs Change in CAL 3 months · Exploratory study-level correlation | Spearman rho 0.100 [-0.859, 0.903] GRADE not reported 5 studies |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Al-Katma 2007 Control of periodontal infection reduces the severity of active rheumatoid arthritis. PMID:17551378 | 2007 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value; DAS28-ESR, change from baseline | not extracted yet |
| de Pablo 2023 (OPERA) Outcomes of periodontal therapy in rheumatoid arthritis: The OPERA feasibility randomized trial. PMID:36415901 | 2023 | this review only | DAS28-CRP, change from baseline; DAS28-ESR, change from baseline; DAS28-ESR, follow-up value | not extracted yet |
| Kaveri 2024 Effect of Periodontal Therapy on Rheumatoid Disease Activity in Patients on Anti-Rheumatoid Drugs - A Prospective Study. PMID:39171606 | 2024 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value; DAS28-ESR, change from baseline | not extracted yet |
| Khare 2016 Nonsurgical Periodontal Therapy decreases the Severity of Rheumatoid Arthritis: A Case-control Study. PMID:27484603 | 2016 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value; DAS28-ESR, change from baseline | not extracted yet |
| Monsarrat 2019 (ESPERA) The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial. PMID:30822490 | 2019 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value; DAS28-ESR, change from baseline | not extracted yet |
| Nakajima 2025 Impact of Periodontal Treatment on Early Rheumatoid Arthritis and the Role of Porphyromonas gingivalis Antibody Titers. PMID:39863920 | 2025 | this review only | DAS28-CRP, change from baseline; DAS28-ESR, change from baseline; DAS28-ESR, follow-up value | not extracted yet |
| Nguyen 2021 Effects of non-surgical periodontal treatment in rheumatoid arthritis patients: A randomized clinical trial. PMID:33792210 | 2021 | this review only | DAS28-CRP, change from baseline; DAS28-ESR, change from baseline; DAS28-ESR, follow-up value | not extracted yet |
| Ortiz 2009 Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor… PMID:19335072 | 2009 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value; DAS28-ESR, change from baseline | not extracted yet |
| Pinho 2009 Relationship between periodontitis and rheumatoid arthritis and the effect of non-surgical periodontal treatment. PMID:20126902 | 2009 | this review only | DAS28-CRP, change from baseline; DAS28-CRP, follow-up value | not extracted yet |
| Thilagar 2022 Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis. PMID:35810012 | 2022 | this review only | DAS28-CRP, change from baseline; DAS28-ESR, change from baseline; DAS28-ESR, follow-up value | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with rheumatoid arthritis and concurrent periodontitis | Adults with rheumatoid arthritis and periodontitis (10 RCTs, n = 430 randomized) |
| Intervention | Steps 1 and 2 of the 2020 EFP S3 guideline (supragingival PMPR and subgingival instrumentation, with or without OHI); adjunctive antimicrobials allowed | Periodontal therapy, mostly PMPR plus subgingival instrumentation with OHI; adjunctive antimicrobials in 2 trials (n=10 trials) |
| Comparison | No periodontal treatment, delayed periodontal treatment, or oral hygiene instructions alone | No treatment, delayed treatment or OHI only (n=10 trials) |
| Outcomes | Change from baseline in DAS28-CRP and DAS28-ESR at 3 and 6 months (co-primary); PPD, CAL (secondary) | DAS28-ESR 3 months (n=5 pooled); DAS28-CRP 3 months (n=4 pooled); DAS28-CRP 6 months (n=2, narrative); PPD and CAL (not pooled) |
| Study designs | Randomized controlled trials (parallel-group or delayed-start) | 10 RCTs |
| Timing | 3 and 6 months post-intervention | Follow-up 1.5 to 12 months; pooled at 3 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | NRSI: N/A · RCT: Yes | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |