Evidence-Based Research on Effectiveness of Periodontal Treatment in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: 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 randomized trials and controlled cohort studies of RA patients with periodontitis was conducted on April 7, 2019, with an update on December 17, 2020 in PubMed, Cochrane Library (CENTRAL), Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trial Registry Platform portal. Two reviewers screened titles and abstracts and selected papers for full-text review. We used Outcome Measures in Rheumatology (OMERACT)-endorsed outcome domains for RA trials and summarized continuous outcomes using standardized 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 1,909 studies identified, 9 (including 10 comparisons) were eligible for quantitative synthesis (n = 388). Evidence suggested a favorable effect of periodontal treatment on disease activity (SMD -0.88 [95% CI -1.38, -0.38]; n = 311). The Grading of Recommendations Assessment, Development and Evaluation (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. CONCLUSION: There is an urgent need for a well-designed prospective cohort study (preferably a randomized controlled trial) of patients with RA and periodontitis using rigorous protocols, standardized diagnostic criteria, data collection, and adequate duration of follow-up.

Cytoskeletal-antigen specific immunoliposome-targeted in vivo preservation of myocardial viability.

Preservation of cell viability using Cytoskeletal-antigen Specific ImmunoLiposomes (antimyosin-CSIL) has been demonstrated in cell cultures. The current study utilized the same CSIL intervention for myocardial protection in an in vivo rabbit model of acute myocardial infarction. Rabbit hearts with experimental left ventricular myocardial infarction were treated with CSIL; control liposomes, [(CL), IgG-liposomes (IgG-L) or plain liposomes (PL)], or vehicle (placebo). Mean myocardial infarct size in rabbit hearts treated in vivo with CSIL was 5 times smaller than in those treated with non-specific CL or vehicle. Treatment of ischemic adult myocardium with CSIL results in significant preservation of myocardial viability by dramatically decreasing the infarct size relative to CL or placebo treatment. Immunohistochemical myocardial preservation of CSIL-treated hearts was confirmed by the lack of contraction band necrosis using histological H&E stains relative to controls. Electrocardiographic confirmation of reduction in myocardial injury after CSIL therapy relative to controls was also observed. Application of CSIL technology to non-cardiac tissues would confirm a broader applicability of this cell membrane lesion sealing technology.