title: Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis.
abstract: OBJECTIVE
  Periodontitis is a potential risk factor for rheumatoid arthritis (RA). This systematic review considers the evidence for whether non-surgical treatment of periodontitis in RA patients has any effect on the clinical markers of RA disease activity.
  
  
  METHODS
  MEDLINE/PubMed, CINAHL, DOSS, Embase, Scopus, Web of Knowledge, MedNar, Lilacs and ProQuest Theses and Dissertations were searched till September 2013 for quantitative studies examining the effect of non-surgical periodontal treatment on disease activity of RA. The following were the inclusion criteria: (1) patients diagnosed with both RA and chronic periodontitis, aged 30 years or older; (2) no antibiotics in the past 3 months or periodontal treatment in the past 6 months; (3) non-surgical periodontal therapy; (4) age- and gender-matched control group; (5) measures of RA activity and (6) published in English.
  
  
  RESULTS
  Five studies met the inclusion criteria. Non-surgical periodontal treatment was associated with significant reductions in erythrocyte sedimentation rate and a trend towards a reduction in TNF-α titres and DAS scores. There was no evidence of an effect on RF, C-reactive protein, anti-cyclic citrullinated protein antibodies and IL-6.
  
  
  CONCLUSIONS
  Based on clinical and biochemical markers, non-surgical periodontal treatment in individuals with periodontitis and RA could lead to improvements in markers of disease activity in RA. All studies had low subject numbers with the periods of intervention no longer than 6 months. Larger studies are required to explore the effect of non-surgical periodontal treatment on clinical indicators of RA, using more rigorous biochemical and clinical outcome measures as well as giving consideration to potential confounding factors of co-morbidity.
authors.affiliation: Department of Dentistry, Colgate Australian Clinical Dental Research Centre, University of Adelaide, South Australia 5005, Australia.
authors.forename: Sushil
authors.initials: S
authors.lastname: Kaur
authors.affiliation: Department of Dentistry, Colgate Australian Clinical Dental Research Centre, University of Adelaide, South Australia 5005, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Bright
authors.affiliation: Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia 5005, Australia; Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Proudman
authors.affiliation: Department of Dentistry, Colgate Australian Clinical Dental Research Centre, University of Adelaide, South Australia 5005, Australia. Electronic address: mark.bartold@adelaide.edu.au.
authors.forename: P Mark
authors.initials: PM
authors.lastname: Bartold
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D012217:Rheumatoid Factor
keywords: Inflammation; Periodontal diseases; Rheumatoid arthritis; Risk factors