Evidence-based research on effectiveness of periodontal treatment in rheumatoid arthritis patients: a systematic review and meta-analysis.

Objectives To gauge the evidence of periodontal therapy's impact on measures of disease activity and systemic inflammatory burden in individuals with rheumatoid arthritis (RA). Methods A search for randomised trials and controlled cohort studies of RA patients with Periodontitis was conducted on 7 April 2019, with an update on 17 December 2020, in PubMed, Cochrane Library (CENTRAL), Embase, http://clinicaltrials.gov/, and WHO-ICTRP portal (PROSPERO: CRD42018103359). Two reviewers screened titles/abstracts and selected papers for full-text review. We used OMERACT-endorsed outcome domains for RA trials and summarised continuous outcomes using standardised mean differences (SMDs) with 95% confidence intervals (95% CIs). We evaluated inconsistency using the I2 statistic and combined SMDs using random-effects models for the meta-analyses; fixed-effect meta-analyses were used for sensitivity analysis. To explore heterogeneity, we added stratified/meta-regression analyses, expressed in T2 . Results Of the 1909 studies identified, 9 (incl. 10 comparisons) were eligible for quantitative synthesis (n = 388). Evidence suggested a favourable effect of periodontal treatment on disease activity (SMD -0.88[95% CI,-1.38 to -0.38], n=311). The GRADE approach was used to judge the estimates' certainty; evidence rated as having 'low' or 'very low-certainty' indicated that any possible effect of periodontal treatment in RA is likely to change as more evidence is provided. Selection bias and RA medication stability were highlighted as sources of heterogeneity between studies. Conclusions There is an urgent need for a well-designed prospective cohort study (preferably an RCT) of patients with RA and Periodontitis using rigorous protocols, standardised diagnostic criteria, data collection, and adequate duration of follow-up.