The Silent Gap: An Exploratory Analysis of Severe Periodontal Breakdown in Rheumatoid Arthritis Despite Stable...

To quantitatively assess gingival crevicular fluid (GCF), periodontal condition, and clinical parameters of Rheumatoid Arthritis (RA) and verify the correspondence between systemic and dental aspects. Investigating the influence of systemic inflammation, polypharmacy, and anticholinergic load on GCF may help to better understand the exacerbation of periodontal destruction in patients with RA.

A cross-sectional study evaluated 33 participants (18 RA, 15 controls). Demographic data, RA activity, functional capacity, anticholinergic burden, polypharmacy (PP), orofacial physical examination, and complete periodontal evaluation were assessed. GCF volume was measured using a Periotron (Oralflow Inc., New York, NY, USA). Statistical analysis included parametric and non-parametric tests, as well as multiple correspondence analysis (p < 0.05).

RA patients exhibited worse periodontal status, with 50% having periodontitis, while 80% of controls had gingivitis, despite similar GCF levels between groups. Multiple correspondence analysis revealed strong associations between advanced periodontitis (stages III/IV grade B), high biofilm (> 20%), bleeding index (> 10%), pocket depth > 4 mm, severe gingival inflammation, higher RA activity, severe functional impairment, PP, and elevated anticholinergic activity. Periodontal health and RA remission were associated with low inflammatory markers, less medication use and absence of immunosuppressive therapy.

RA patients had greater periodontal impairment despite similar GCF volumes. Strong associations were observed between periodontal severity, RA activity, PP, and anticholinergic burden, suggesting GCF involvement in periodontal disease progression in RA, highlighting underexplored clinical connections.