Efficacy of baricitinib on periodontal inflammation in patients with rheumatoid arthritis

Objective: Despite a widely recognized bidirectional pathobiologic relationship between rheumatoidarthritis (RA) and periodontal disease, the impact of innovative anti-rheumatic drugs in modulatingnot only inflammatory and immune articular damage, but also periodontal microenvironment remainsdebatable. We aimed to evaluate the periodontal status in RA with and without baricitinib, a Janus kinase( JAK) inhibitor, and to better describe association between these entities. Methods: We performed a prospective longitudinal 24-weeks study in 21 active RA initiating baricitinib. Standard assessments included a dual rheumatologic (RA activity, disability, serological, inflammatoryprofile) and dental evaluation comprising plaque index, gingival index, bleeding on probing, probingdepth, clinical attachment level. Results: More than half of RA presented at baseline with chronic periodontitis, as suggested by high prevalence of sites with dental plaque, abnormal bleeding on probing, probing depth and clinical attachmentlevel. Aggressive periodontal disease was reported particularly in disease subsets with excessive inflammatory (serum C reactive protein level) and serologic biomarkers (anti-citrullinated peptide antibodies). Furthermore, significant correlations between dental pathology, disease activity and ACPA levels werealso reported (P < 0.05). Consistent improvement was noticed in both rheumatoid arthritis characteristicsand periodontal status after 24 weeks of baricitinib (P < 0.05). Conclusion: RA, particularly severe active ACPA-positive disease, is basically associated with altered periodontal health. JAK blockade through oral baricitinib may be efficient in patients with active RA andpotentially able to modulate the inflammatory process in the periodontal tissue. (C) 2020 The Authors. Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)