Periodontal Status, Oral Inflammatory Biomarker, and Relative Expression of Red Complex Bacteria in Periodontitis with Rheumatoid Arthritis Treated with Methotrexate

Abstract Objectives To determine the differences in periodontal status—Probing Depth (PD), Clinical Attachment Loss (CAL), Bleeding on Probing (BOP); oral inflammatory biomarkers—Tumor Necrosis Factor Alpha (TNF-α), Interleukin 1 Beta (IL-1β), Prostaglandin E2 (PGE2); and the relative expression of red complex bacteria—Porphyromonas gingivalis (Pg), Treponema denticola (Td), and Tannerella forsythia (Tf) among groups with periodontitis, periodontitis accompanied by rheumatoid arthritis (RA) before treated with methotrexate (MTX), and periodontitis with RA treated with MTX for one month. Material and Methods A cross-sectional study by analyzing periodontal clinical parameters, gingival crevicular fluid (GCF) inflammatory biomarker levels, and subgingival plaque relative expression of red complex bacteria. Samples were taken from patients with periodontitis, periodontitis with RA without MTX, and periodontitis with RA treated with MTX. Samples were collected from the Rheumatology Clinic of Dr. Cipto Mangunkusumo General Hospital, and the Periodontology Clinic of the Dental Teaching Hospital, Faculty of Dentistry, Universitas Indonesia patients. Biomarkers were analysed using the Enzyme-Linked Immunosorbent Assay (ELISA) and bacterial expression was measured using real-time polymerase chain reaction (RT-PCR). Statistical Analysis One-way ANOVA with Tukey’s post-test and Kruskal-Wallis with Dunn’s post-test were used to analysed periodontal parameters, GCF biomarkers, and bacterial expression among the groups. Results No statistically significant differences (p > 0.05) were found for PD and CAL. BOP ​​were significantly higher in the periodontitis group than the RA without MTX group. All biomarkers level were significantly increased in the RA without MTX group compared to the periodontitis group. No significant difference in bacterial expression among groups. Pg and Td expression were significantly higher in the periodontitis group compared to RA without MTX group. Conclusions Patients with periodontitis and RA without MTX exhibited significantly higher inflammatory biomarkers levels, indicating an amplified inflammatory response and tended to be reduced by the MTX. Pg and Td expression was higher in the periodontitis-only group. These findings suggest that RA and its treatment influence both the host inflammatory response and microbial profile in periodontitis.