- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02779179
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.
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.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
-
Bordeaux, France, 33000
- CHU de Bordeaux
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Toulouse, France, 31059
- Pôle Odontologie Hôpital Purpan - Pavillon Rayer
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
INCLUSION CRITERIA:
- 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
EXCLUSION CRITERIA:
- 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.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Immediate Periodontal treatment group
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Active Comparator: Delayed Periodontal treatment Group
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|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Evaluation of parodontitis therapeutic care as assessed by variation in DAS28 score
Time Frame: Day 15 and day 90
|
Day 15 and day 90
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Evaluation of parodontitis therapeutic care as assessed by variation in ACR 20 score
Time Frame: Day 15 and day 90
|
Day 15 and day 90
|
Evaluation of parodontitis therapeutic care as assessed by variation in HAQ score
Time Frame: Day 15 and day 90
|
Day 15 and day 90
|
Evaluation of parodontitis therapeutic care as assessed by variation in GOHAI score
Time Frame: Day 15 and day 90
|
Day 15 and day 90
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Paul MONSARRAT, MD, Faculté de chirurgie dentaire - Toulouse
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 10 046 08
- 2010-A01193-36 (Registry Identifier: National Agency of Drug Safety and Health Products)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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