The Synergetic Effect of Periodontal Therapy and TNF-α Inhibitor for the Treatment of Comorbid Periodontitis and Psoriasis

Aim: To assess the adjunctive effect of periodontal therapy on psoriasis-related outcomes in a combined experimental model of ligature-induced periodontitis and Imiquimod (IMQ)-induced psoriasis. Also, this experiment aimed to study the impact of TNF-α inhibitors on the periodontium. Methods: Fifty-six C57/BL6J mice were randomly allocated to seven experimental groups: (a) control group (P–Pso–) with no treatment; (b) periodontitis (P+Pso–) with periodontal therapy; (c) periodontitis (P+Pso–) with TNF-α inhibitor; (d) psoriasis (P–Pso+) with TNF-α inhibitor; (e) periodontitis and psoriasis (P+Pso+) with periodontal therapy; (f) P+Pso+ with TNF-α inhibitor; and (g) P+Pso+ with both periodontal therapy and TNF-α inhibitor. Samples (maxilla, dorsal skin and blood) were harvested immediately after death. Measures of periodontitis distance between the cemento-enamel junction and alveolar bone crest (CEJ–ABC) and number of osteoclasts and psoriasis (epidermal thickness and infiltrate cells (per 0.03mm2)) severity, as well as systemic inflammation (IL-6, IL-17A and TNF-α) were collected. Results: In the P+Pso+ group, a significant adjunctive effect of periodontal therapy to TNF-α inhibitors was found in the reduction of epidermal thickening and inflammatory infiltrate of the dorsal skin (p < 0.05). Similarly, treatment with TNF-α inhibitor resulted in a significant adjunctive effect to periodontal therapy in the reduction of alveolar bone loss (p < 0.05). These changes were accompanied by a significant decrease in the circulating levels of IL-6 and IL-17A when both periodontal therapy and TNF-α inhibitor were administered. Conclusions: The combination of periodontal therapy and TNF-α inhibitor showed a positive synergetic effect in the treatment of comorbid experimental ligature-induced periodontitis and IMQ-induced psoriasis via the reduction of systemic inflammation.