The effect of anti-tumor necrosis factor-alpha and nonsurgical periodontal therapy in individuals with rheumatoid arthritis

BACKGROUND: TNF-α inhibitors (anti-TNF-α) decrease the amount of inflammatory cells, osteoclast formation, and bone loss. The purpose of this study was to investigate the effect of non-surgical periodontal therapy (NSPT) combined with anti-TNF-α on oxidative stress in individuals with RA and periodontitis. METHODS: A total of 42 patients with RA and periodontitis who were treated with anti-TNF-α (n = 21) and not treated with anti-TNF-α (n = 21) were included in the study. Plaque index (PI), bleeding on probing (BOP), gingival index (GI), clinical attachment loss (CAL), and probing pocket depth (PPD) measurements were measured at baseline, at 3 months, and at 6 months after NSPT, and serum and gingival crevicular fluid (GCF) samples were obtained from the patients. RANKL/OPG, MMP-8, MDA, GSH, and OSI levels were evaluated using ELISA. RESULTS: In both groups, baseline PI, BOP, GI, PPD, and CAL decreased significantly after NSPT (p < 0.05). The GCF RANKL/OPG ratio was statistically significantly lower in anti-TNF-α treated patients at baseline and at 6 months post-NSPT (p < 0.05), and the serum OSI was significantly higher in anti-TNF-α treated patients at baseline (p < 0.05). GCF MMP-8 increased significantly after NSPT in both groups compared with baseline (p < 0.05). In those treated with anti-TNF-α, OSI and MDA decreased significantly after NSPT (p < 0.05). CONCLUSIONS: The data from this study suggest that anti-TNF-α therapy can suppress inflammation and alveolar bone resorption by affecting the RANKL/OPG ratio, MMP-8, and oxidative stress parameters, and thus increase the effectiveness of NSPT. TRIAL REGISTRATION: This study was retrospectively registered on ClinicalTrials.gov (NCT06818045), 2025-02-02.