Therapeutic Management of Periodontitis and Clinical Manifestations of Rheumatoid Arthritis
ESPERA
Efficacy of Therapeutic Management of Periodontitis on the Clinical Manifestations of Rheumatoid Arthritis: the Randomized, Controlled ESPERA Trial.
2 other identifiers
interventional
22
1 country
2
Brief Summary
Although RA pathomechanisms remains incompletely understood, periodontitis and RA share pathogenic features : genetic and environmental influences, chronic inflammatory disease, immunoregulatory imbalance, bacterial factors, persistence of antigen/peptide and clinical factors (conjunctive and hard tissues destruction). Several hypothesis can be evocated : Gram negative bacterial systemic spreading, inflammatory transmitter substance systemic spreading (IL1, IL6, IL17, PGE2), systemic spreading of bacterial degradation products (LPS for example). Currently Porphyromonas gingivalis (PG) might be a susceptibility factor to RA because PG has an enzyme, the peptidylarginine deiminase leading to auto antibodies creation and RA increasing. As periodontitis, RA is chronic disease with a cyclic increase evolution, needing a complex pluridisciplinary treatment approach. Recent studies have reported an increased prevalence of RA patients with periodontal disease. Others studies show that periodontal treatment induces a significant decrease of the sedimentation rate and of the DAS28. Periodontitis is suspected to be an independent, aggravating factor in patients with RA (given the definition from NIH : an aggravating factor is something that makes a condition worse). So periodontal treatment cannot be considered as a RA treatment per se. But it is hypothesised that treating periodontitis in RA patients showing signs of periodontitis could result in improvement in RA disease activity. To date the role of periodontitis as an aggravating factor in these patients remains unclear, and only RCT designs can reasonably be used to test this causal hypothesis. There still remains some RA patients who have persistent symptoms and frequent exacerbations despite specialist care and continuous treatment, so results of treating aggravating factors are needed. As the majority of patients will benefit from a systematic evaluation and treatment of aggravating factors, the periodontal treatment strategy need to be tested. The aim of this randomised controlled trial is to assess the effectiveness of periodontal treatment for rheumatoid arthritis patients. To assess the effectiveness of periodontal treatment to reduce the severity of rheumatoid arthritis (RA), in patients suffering from both periodontitis and rheumatoid arthritis. The hypothesis is that periodontal treatment reduce the severity of rheumatoid arthritis.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at below P25 for not_applicable
Started Nov 2010
Longer than P75 for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
November 1, 2010
CompletedFirst Submitted
Initial submission to the registry
July 10, 2015
CompletedFirst Posted
Study publicly available on registry
May 20, 2016
CompletedPrimary Completion
Last participant's last visit for primary outcome
November 1, 2016
CompletedStudy Completion
Last participant's last visit for all outcomes
November 1, 2016
CompletedDecember 10, 2025
November 1, 2018
6 years
July 10, 2015
December 2, 2025
Conditions
Outcome Measures
Primary Outcomes (1)
Evaluation of parodontitis therapeutic care as assessed by variation in DAS28 score
Day 15 and day 90
Secondary Outcomes (3)
Evaluation of parodontitis therapeutic care as assessed by variation in ACR 20 score
Day 15 and day 90
Evaluation of parodontitis therapeutic care as assessed by variation in HAQ score
Day 15 and day 90
Evaluation of parodontitis therapeutic care as assessed by variation in GOHAI score
Day 15 and day 90
Study Arms (2)
Immediate Periodontal treatment group
EXPERIMENTALDelayed Periodontal treatment Group
ACTIVE COMPARATORInterventions
* Mechanical debridement (scaling, root planning, subgingival curettage) * Antimicrobial therapy (systematically administered: amoxicillin or clindamycin). * Antiseptic mouthrinses, gel or dentifrice * Oral hygiene instructions (to educate and motivate patients to control the accumulation of plaque and calculus)
Eligibility Criteria
You may qualify if:
- rheumatoid arthritis diagnosed for at least one year
- DAS28 score between 3.2 and 5.1
- no change to medication, dosage or formulation in RA treatment during the 3 months preceding the screening visit
- subject available for all study visits over three months in the Dental Care Departments (V1 to V4)
- subjects with at least six natural teeth with root
- subject with periodontitis, defined by the presence of one site with periodontal probing depth ≥ 4 mm and clinical attachment level ≥ 3 mm on at least 4 teeth.
- subject has given his informed consent: 1 week cooling-off period
You may not qualify if:
- subject will not qualify for enrolment if he presents at least one of the following: acute oral infection, acute oral pain (including pulpitis), suspicious oral mucosal lesion, severe oral inflammation unrelated to periodontal conditions, or need for immediate tooth extractions
- have a planned hospitalization within 4 months after the screening visit
- subject suffering from one or more known infectious diseases (HIV, hepatitis, infectious mononucleosis),
- subject suffering from known clinically significant renal disease (creatinine clearance \<60 ml/min), or liver disease,
- unbalanced diabetes
- have a known risk of endocarditis,
- have a permanent pacemaker,
- subject taking antithrombotic treatment,
- subject having severe difficulties in understanding written and spoken French
- for females: are pregnant or intending to become pregnant, or lactating
- subject suffering from a chronic disorder that requires chronic or intermittent use of antibiotics,
- subject having known hypersensitivity to chlorhexidine gluconate
- are participating in another intervention study
- have known contraindications to both amoxicillin and clindamycin
- have known contraindications to dental local anesthetic.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
CHU de Bordeaux
Bordeaux, 33000, France
Pôle Odontologie Hôpital Purpan - Pavillon Rayer
Toulouse, 31059, France
Related Publications (2)
Monsarrat P, Vergnes JN, Cantagrel A, Algans N, Cousty S, Kemoun P, Bertrand C, Arrive E, Bou C, Sedarat C, Schaeverbeke T, Nabet C, Sixou M. Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis: study protocol of the randomized, controlled ESPERA trial. Trials. 2013 Aug 14;14:253. doi: 10.1186/1745-6215-14-253.
PMID: 23945051RESULTMonsarrat P, Fernandez de Grado G, Constantin A, Willmann C, Nabet C, Sixou M, Cantagrel A, Barnetche T, Mehsen-Cetre N, Schaeverbeke T, Arrive E, Vergnes JN; ESPERA Group. The effect of periodontal treatment on patients with rheumatoid arthritis: The ESPERA randomised controlled trial. Joint Bone Spine. 2019 Oct;86(5):600-609. doi: 10.1016/j.jbspin.2019.02.006. Epub 2019 Feb 26.
PMID: 30822490RESULT
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Paul MONSARRAT, MD
Faculté de chirurgie dentaire - Toulouse
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
July 10, 2015
First Posted
May 20, 2016
Study Start
November 1, 2010
Primary Completion
November 1, 2016
Study Completion
November 1, 2016
Last Updated
December 10, 2025
Record last verified: 2018-11
Data Sharing
- IPD Sharing
- Will not share