Rheumatoid arthritis and periodontal disease: association between microbiome and disease-modifying drugs

Abstract

Rheumatoid Arthritis (RA) is an inflammatory systemic disease that affects joints. There is a similarity between pathways that induce tissue destruction in RA and Periodontal Disease (PD), a chronic inflammatory condition that affect tooth surrounding structures. One of mechanisms that link RA and PD evolve dysbiosis of oral microbiome, which is partially reversed after treatment with synthetic or biological Disease-Modifying Drugs (DMDs), respectively Methotrexate (MTX) and anti-TNF. Despite significant progress in treatment of RA with these medications, 30-40% of patients discontinue treatment because of inefficacy and adverse events. There are some suggested mechanisms to explain treatment failure but they are not conclusive yet. In this context, the analysis of microbiome in patients under MTX and anti-TNF may point specific differences in patients responsive and non-responsive to DMDs. The objectives of this project are: 1) Monitoring oral and intestinal microbiome and clinical and periodontal parameters in patients with RA under DMDs therapy, 2) To verify possible effects of DMDs on the oral and intestinal microbiome using an experimental RA model, 3) If data point the association of microbiome dysbiosis with DMDs, we will test if probiotic treatment is able to reverse the effects. The results might contribute improving strategies to monitoring treatment response in RA patients. (AU)