26 January 2025: Clinical Research
Impact of Periodontal Treatment on Early Rheumatoid Arthritis and the Role of Antibody Titers
Yoichiro Nakajima

DOI: 10.12659/MSM.947146
Med Sci Monit 2025; 31:e947146
Abstract
BACKGROUND: Periodontal disease and rheumatoid arthritis (RA) are closely related, and periodontal therapy can potentially improve RA activity. However, it is not clear in which RA patient populations are more effective periodontal therapy for RA treatment. This study aimed to evaluate the effects of treatment for periodontal disease in 30 patients with rheumatoid arthritis and the titers of antibodies to Porphyromonas gingivalis (P. gingivalis).
MATERIAL AND METHODS: Thirty patients with RA with mild to severe periodontitis were divided into 3 groups based on the timing of periodontal therapy initiation. RA activity was assessed at baseline and at 3, 6, 9, and 12 months for comparison across groups. Additionally, serum P. gingivalis antibody titers were measured at baseline, patients were divided into 3 groups based on their levels, and their RA activity was compared after 12 months.
RESULTS: Patients who started periodontal therapy concurrently with RA treatment initiation at baseline showed greater improvement in RA activity, measured by disease activity score, including 28 joints using C-reactive protein (DAS28-CRP), from baseline to 3 months than those who started periodontal therapy after RA treatment. Additionally, RA activity by DAS28-CRP after 12 months of RA treatment with periodontal therapy was significantly improved in patients with higher baseline serum IgG antibody titers against P. gingivalis than in those with lower titers.
CONCLUSIONS: Treatment for periodontal disease in patients with RA is more effective in patients with early-phase RA and higher serum P. gingivalis antibody titers.
Keywords: Arthritis, Rheumatoid, periodontal diseases, Serum Bactericidal Antibody Assay
Introduction
The incidence of rheumatoid arthritis (RA) is increasing worldwide, with an estimated prevalence of approximately 0.5% [1,2]. RA is characterized by chronic inflammation of the synovial membrane of the joints and progressive destruction of cartilage and erosion of marginal bone, causing clinical symptoms such as joint pain, stiffness, and disability, and is associated with systemic complications and increased mortality. Periodontal disease is a bacterial infection and inflammation affecting tooth-supporting tissues. Periodontal diseases are classified into 2 major categories. The first is gingivitis, an inflammation of the gingiva, limited to the soft-tissue areas of the gingival epithelium and connective tissue. The second is periodontitis, an inflammation of the tooth-supporting tissues that causes attachment loss and alveolar bone destruction. Severe periodontitis is one of the most serious and widespread diseases, with a global prevalence of 50% [3,4].
Growing evidence suggests a close association between periodontal disease and RA [5]. Epidemiologically, the incidence of periodontal disease in patients with RA is high, and the severity of periodontal disease is associated with RA activity, indicating a reciprocal association between periodontal disease and RA [6]. Periodontal disease is caused by bacterial infection of periodontal tissues, whereas RA is an inflammatory arthritis associated with autoantibodies targeting modified autoepitopes. Although their etiologies differ, both are chronic inflammation diseases, resulting in the progressive destruction of connective tissue and bone due to the dysregulation of local inflammatory processes. These diseases are also affected by common genetic and environmental risk factors [7], suggesting that both diseases may influence each other. Recent findings have shown that periodontal disease is a potential risk factor for RA and that periodontal tissue health is important in patients with RA [8].
Periodontal therapy for patients with RA has been shown to improve periodontal tissue health and RA disease activity [9–11]. However, most studies have examined the impact of periodontal therapy on patients with RA who have undergone treatment and with a longer disease duration. Therefore, whether the effect of periodontal therapy varies with the RA phases remains unclear. Since periodontal disease and bacteria have been suggested as possible triggers of RA [12], periodontal therapy might be more effective if initiated before the RA onset or in its early phase. Therefore, identifying the optimal RA phase for initiating periodontal therapy is necessary.
Recently,
To date, the efficacy of periodontal therapy in different RA patient populations, such as the timing of initiation of periodontal therapy and baseline serum IgG antibody titers to
Material and Methods
ETHICAL STATEMENT:
This study was conducted in accordance with the Declaration of Helsinki and its latest amendments, and was approved by the Ethics Committee of Osaka Medical and Pharmaceutical University, Takatsuki City, Japan (approval numbers 1696 and 2817). All patients provided written informed consent before participating in the study.
PARTICIPANTS:
Participants were selected from patients diagnosed with RA at the Department of Rheumatology and Collagen Disease, Osaka Medical and Pharmaceutical University Hospital, and referred to the Department of Dental and Oral Surgery. RA was defined by the presence of at least 4 of the following 7 criteria: morning stiffness, arthritis of 3 or more joint areas, symmetric arthritis, arthritis of hand joints, rheumatoid nodules, serum rheumatoid factor, and radiographical changes [25]. Exclusion criteria included patients undergoing treatment for periodontal disease or with a history of dental visits within the past 6 months; patients with severe periodontitis, acute symptoms, or other conditions for which delayed periodontal treatment was significantly disadvantageous; and patients receiving biological disease-modifying antirheumatic drugs (bDMARDs).
STUDY DESIGN:
Participants were divided into 3 groups according to the timing of periodontal therapy initiation for RA treatment. At baseline, some patients had no history of RA treatment, while others were already undergoing RA treatment. Patients with no history of RA treatment were randomly assigned to either Group A, where periodontal therapy began concurrently with RA treatment at baseline, or Group B, where RA treatment started at baseline and periodontal therapy was initiated 3 months later. Randomization was performed by independent staff using sealed envelopes to randomly assign patients to groups A and B. Patients already receiving RA treatment at baseline were assigned to Group C, where periodontal therapy was initiated at baseline. At each time point, periodontal therapy, including oral hygiene instruction, scaling, and root planing, was performed depending on the degree of periodontal lesions.
Participants’ medical records provided information on their age, sex, medical history, and medications. RA and periodontal disease status were assessed at baseline and at 3, 6, 9, and 12 months. Serum IgG antibody titers against
This study was registered with the UMIN Clinical Trials Registry (
CLINICAL ASSESSMENT OF RA:
To assess RA status, 2 rheumatologists examined joint tenderness and swelling in all patients. As a parameter of RA disease activity, we calculated disease activity score including 28 joints using C-reactive protein (DAS28-CRP), disease activity score including 28 joints using erythrocyte sedimentation rate (DAS28-ESR), simplified disease activity index (SDAI), and clinical disease activity index (CDAI). RA disease activity level was classified by DAS28-CRP as remission (DAS28-CRP <2.3), low (2.3≤ DAS28-CRP ≤2.7), medium (2.7< DAS28-CRP ≤4.1), and high (DAS28-CRP >4.1.) [26,27].
ULTRASONOGRAPHIC ASSESSMENT OF RA:
On the same day as the physical examination, patients underwent ultrasonographic (US) assessment by 2 sonographers. Twenty-eight joints (bilateral knees, shoulders, elbows, wrists, MCP joints 1–5, proximal IP joints 1–5) were examined using musculoskeletal ultrasound in grayscale (GS) and power Doppler (USPD) modes of the US diagnostic system (Viamo, Toshiba Medical Systems, Ibaraki, Japan). A semi-quantitative scoring scale (grade 0: absent; grade 1: mild; grade 2: moderate; grade 3: marked) [28] was used for each parameter of synovial hypertrophy by USGS and for blood flow by USPD enhancement. The total USGS and USPD scores were calculated by summing the scores for all 28 joints [29].
ASSESSMENT OF PERIODONTAL DISEASE:
To assess periodontal status, a full-mouth clinical examination was performed by a certified dentist. Periodontal pocket depth (PPD) and bleeding on probing (BOP) were measured by using a periodontal probe (Figure 1) at all 6 tooth sites, and the periodontal inflammatory surface area (PISA), a periodontal disease parameter that quantifies the amount of inflammation in periodontal tissue, was calculated [30]. The severity of periodontitis was classified as no periodontitis, mild, moderate, or severe according to the Centers for Disease Control and Prevention in collaboration with the American Academy of Periodontology (CDC/AAP) periodontitis case definition [31].
:
Serum antibody titers against P. gingivalis were measured using chemiluminescent enzyme immunoassay with a flow-through membrane and chemiluminescent immunoautomatic analyzer (Toyobo, Osaka, Japan) with a reagent cartridge according to the manufacturer’s instructions, as previously described [32]. The arginine gingipain (Rgp) sequence of P. gingivalis was used as the antigen [33]. Briefly, the principle of this measurement system is based on a flow-through membrane immunoassay using 2 antigens, 1 of which is biotinylated and the other bound to alkaline phosphatase (ALP). Immune complexes formed by serum antibodies and the 2 antigens are captured on an anti-biotin antibody coated membrane in a reaction vessel, and the ALP activity is measured.
The serum from patients with periodontitis in whom
Participants were divided into 3 groups – high, moderate, and low – based on quartiles of baseline serum antibody titers to
STATISTICAL ANALYSIS:
Baseline characteristics of patients were evaluated using the Mann-Whitney U test or the Kruskal-Wallis test for quantitative data and the chi-square test for categorical data. RA parameters were compared between groups by Kruskal–Wallis test or Mann-Whitney U test. Changes over time from baseline (ie, within-group comparisons) were evaluated by Friedman tests or Wilcoxon signed rank test. IBM SPSS version 27 was used for statistical analysis, with a
Results
PARTICIPANTS:
A flowchart of the study participants, including reasons for exclusion, is shown in Figure 2. Of the 43 individuals assessed for eligibility, 34 were eligible for inclusion. Nineteen patients without prior RA treatment were randomly assigned to Group A (n=9), where periodontal therapy began simultaneously with RA treatment, or Group B (n=10), where periodontal therapy was performed 3 months after initiating RA treatment. Among the 15 patients who had already undergone RA treatment, 4 were excluded because of loss to follow-up, and 11 started periodontal therapy at baseline (Group C).
BASELINE CHARACTERISTICS:
The baseline characteristics of the participants in each group at different initiation timing of periodontal therapy are shown in Table 1. Age, sex, oral condition, and serum P. gingivalis antibody titers did not differ significantly across groups. The degree of periodontal disease in the patients in each group ranged from mild to severe periodontitis, with no significant differences between the groups. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) were used in all patients in Group C at baseline and in all patients in Groups A, B, and C at the 12-month observation period.
DIFFERENCES IN THE EFFECTS OF PERIODONTAL THERAPY BY INITIATION TIMING:
At baseline, no differences in RA activity were observed between Groups A and B. Patients in Groups A and B, which started RA treatment at baseline, showed significant improvements in DAS28-CRP, SDAI, and CDAI scores after 3 months of RA treatment compared to baseline (P<0.05). After 3 months, DAS-ESR improved in Group A, but not in Group B. Ultrasound results showed improvement in USPD after 6 months in Group B and after 12 months in Group A (P<0.05, Table 2).
Group A, which started periodontal therapy simultaneously with RA treatment, showed no difference in the RA index at any time point compared to Group B, which started periodontal therapy 3 months after RA treatment (Table 2). However, the improvement in RA activity, measured by DAS28-CRP, from baseline to 3 months was greater in Group A than in Group B (P<0.05, Figure 3), although subsequent changes were similar between both groups. After 3 months, 77.8% in Group A had RA activity levels in remission based on DAS28-CRP, compared to 30.0% in Group B (Table 3).
Furthermore, we compared Groups A and C, where periodontal therapy was initiated at baseline. Group C, which had previously started RA treatment at baseline, showed no significant difference in RA indices at any time point, and no differences in the RA index were observed at any time point in Group A compared with Group C (Table 2). The improvement in RA activity by DAS28-CRP from baseline to 3 months was greater in Group A than in Group C (P<0.01, Figure 3). The number of patients at each disease activity level based on DAS28-CRP at each time point did not differ significantly between Groups A and C (Table 3).
These results suggest that patients who start periodontal therapy at an early stage of RA treatment have the potential for early improvements in RA activity.
:
Since no significant differences in RA activity were observed after 12 months among Groups A, B, and C (Tables 2, 3), participants were divided into 3 groups based on quartiles of baseline serum IgG antibody titers against P. gingivalis: high (H), medium (M), and low (L) groups. RA activity after 12 months of RA treatment with periodontal therapy was then compared among these groups. P. gingivalis antibody titers at baseline were significantly different in each group (Figure 4A). At baseline, the number of teeth bleeding at probing and the degree of periodontal disease differed significantly between groups (P<0.05, Table 4). While RA activity by DAS28-CRP was not significantly different between the groups at baseline (Figure 4B), Group L had higher DAS28-CRP than group M after 12 months of treatment (P<0.05, Figure 4C), with no significant differences in other indices. After 12 months, the RA activity level measured by DAS28-CRP was in remission in 37.5%, 76.9%, and 75.0% of the patients in Groups L, M, and H, respectively (Table 5). The change in the proportion of patients per RA activity level from baseline to 12 months was not seen in Group L, but improved in Groups M and H (Table 5). These results suggest that RA treatment with periodontal therapy may be more effective in improving RA activity in patients with higher baseline serum IgG antibody titers against P. gingivalis than in those with lower titers.
Discussion
In this study, periodontal therapy was administered alongside RA treatment, and its effects were compared across groups with different initiation times of periodontal therapy and groups with different serum
Periodontal therapy has been reported to improve RA activity [8,9]. In this study, when periodontal therapy was initiated simultaneously with RA treatment in untreated RA patients, there was a greater improvement in RA activity based on DAS28-CRP at 3 months compared with no periodontal therapy. In addition, RA-untreated patients had a greater improvement in RA activity 3 months after the start of periodontal therapy than did patients who had already started RA treatment (duration of treatment: 5 months to 7 years).These results are consistent with those of several previous studies that reported short-term improvements in DAS28 with periodontal treatment in patients with RA [9,10,34]. However, previous reports did not consider the duration of RA treatment or the duration of RA treatment in years [11]. A novel finding of this study is that starting periodontal therapy alongside RA treatment at diagnosis may benefit early RA remission.
Additionally, there was no difference in RA disease activity at 1-year observation between untreated and treated RA patients in groups that started periodontal therapy at different times. Few related studies have reported follow-up data of up to 1 year, confirming the findings reported for the short-term effect of periodontal therapy in RA treatment. Randomized trials, such as the present study, comparing immediate and delayed periodontal therapy in patients with RA have been reported as pilot studies [35]. Therefore, further large-scale studies focusing on the timing of periodontal therapy initiation are needed.
The observed improvement in RA activity is likely due to periodontal therapy suppressing periodontal infection and inflammation [8]. However, in this study, periodontal treatment did not significantly improve periodontal status. This may be due to the inclusion of individuals with mild or no periodontal disease, as patients were not selected based on periodontal disease severity. Despite this, it is noteworthy that periodontal therapy was effective in improving RA activity.
In this study, the improvement in RA activity after 1 year of RA treatment with periodontal therapy was significantly greater in patients with higher baseline serum IgG antibody titers against
This study has a few limitations. First, owing to the nature of this interventional study, the sample size was small. The sample size of 30 patients was determined based on clinical judgment and practical considerations, not formal statistical inference. Second, as this was a randomized controlled trial, baseline periodontal status and RA treatment were not perfectly matched. Third, although patients treated with bDMARDs at baseline were initially excluded, some participants changed their medication regimen during the 1-year follow-up period, including bDMARDs, and were not excluded afterward. Recently, RA medications have been shown to affect periodontal health [38], which may be an important factor in evaluating the efficacy of periodontal therapy in RA treatment. Among RA drugs, the efficacy of bDMARD is associated with periodontal disease; that is, RA patients with a low severity of periodontal disease have a better clinical response to bDMARD therapy [23,39]. Therefore, the results of this study may have been influenced by the differences in RA treatment, and future studies should be conducted to eliminate this influence. This was a preliminary pilot project with a limited sample size, necessitating a more extensive, well-controlled study to confirm and thoroughly examine our findings.
Conclusions
Treatment for periodontal disease in patients with RA is more effective in patients with early-phase RA and higher serum
Figures




Tables
Table 1. Baseline characteristics of the patients in each group with different timing of periodontal treatment initiation.




References
1. , Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021: Lancet Rheumatol, 2023; 5(10); e594-e610
2. Almutairi KB, Nossent JC, Preen DB, The prevalence of rheumatoid arthritis: A systematic review of population-based studies: J Rheumatol, 2021; 48(5); 669-76
3. Chen MX, Zhong YJ, Dong QQ, Global, regional, and national burden of severe periodontitis, 1990–2019: An analysis of the Global Burden of Disease Study 2019: J Clin Periodontol, 2021; 48(9); 1165-88
4. Cui Y, Tian G, Li R, Epidemiological and sociodemographic transitions of severe periodontitis incidence, prevalence, and disability-adjusted life years for 21 world regions and globally from 1990 to 2019: An age-period-cohort analysis: J Periodontol, 2023; 94(2); 193-203
5. Krutyhołowa A, Strzelec K, Dziedzic A, Host and bacterial factors linking periodontitis and rheumatoid arthritis: Front Immunol, 2022; 13; 980805
6. Potempa J, Mydel P, Koziel J, The case for periodontitis in the pathogenesis of rheumatoid arthritis: Nat Rev Rheumatol, 2017; 13(10); 606-20
7. de Pablo P, Chapple IL, Buckley CD, Dietrich T, Periodontitis in systemic rheumatic diseases: Nat Rev Rheumatol, 2009; 5(4); 218-24
8. Kobayashi T, Bartold PM, Periodontitis and periodontopathic bacteria as risk factors for rheumatoid arthritis: A review of the last 10 years: Jpn Dent Sci Rev, 2023; 59; 263-72
9. Sun J, Zheng Y, Bian X, Non-surgical periodontal treatment improves rheumatoid arthritis disease activity: A meta-analysis: Clin Oral Investig, 2021; 25(8); 4975-85
10. Kaur S, Bright R, Proudman SM, Bartold PM, Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis: Semin Arthritis Rheum, 2014; 44(2); 113-22
11. Mustufvi Z, Twigg J, Kerry J, Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review: Rheumatol Adv Pract, 2022; 6(2); rkac061
12. Cheng Z, Meade J, Mankia K, Periodontal disease and periodontal bacteria as triggers for rheumatoid arthritis: Best Pract Res Clin Rheumatol, 2017; 31(1); 19-30
13. Perricone C, Ceccarelli F, Saccucci M: Curr Opin Rheumatol, 2019; 31(5); 517-24
14. Li Y, Guo R, Oduro PK: Front Cell Infect Microbiol, 2022; 12; 956417
15. How KY, Song KP, Chan KG: Front Microbiol, 2016; 7; 53
16. Hajishengallis G, Darveau RP, Curtis MA, The keystone-pathogen hypothesis: Nat Rev Microbiol, 2012; 10(10); 717-25
17. Kudo C, Naruishi K, Maeda H, Assessment of the plasma/serum IgG test to screen for periodontitis: J Dent Res, 2012; 91(12); 1190-95
18. Dye BA, Herrera-Abreu M, Lerche-Sehm J, Serum antibodies to periodontal bacteria as diagnostic markers of periodontitis: J Periodontol, 2009; 80(4); 634-47
19. Koziel J, Potempa J, Pros and cons of causative association between periodontitis and rheumatoid arthritis: Periodontol 2000, 2022; 89(1); 83-98
20. Curran AM, Girgis AA, Jang Y, Citrullination modulates antigen processing and presentation by revealing cryptic epitopes in rheumatoid arthritis: Nat Commun, 2023; 14(1); 1061
21. Ahmadi P, Mahmoudi M, Kheder RK: Int Immunopharmacol, 2023; 118; 109936
22. Bender P, Bürgin WB, Sculean A, Eick S: Clin Oral Investig, 2017; 21(1); 33-42
23. Kobayashi T, Ito S, Murasawa A, Periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: A 1-year follow-up study: Mod Rheumatol, 2023; 33(1); 81-87
24. Takeuchi-Hatanaka K, Koyama Y, Okamoto K, Treatment resistance of rheumatoid arthritis relates to infection of periodontal pathogenic bacteria: A case-control cross-sectional study: Sci Rep, 2022; 12(1); 12353
25. Arnett FC, Edworthy SM, Bloch DA, The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis: Arthritis Rheum, 1988; 31(3); 315-24
26. Anderson J, Caplan L, Yazdany J, Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice: Arthritis Care Res (Hoboken), 2012; 64(5); 640-47
27. Inoue E, Yamanaka H, Hara M, Comparison of Disease Activity Score (DAS)28- erythrocyte sedimentation rate and DAS28- C-reactive protein threshold values: Ann Rheum Dis, 2007; 66(3); 407-9
28. Szkudlarek M, Court-Payen M, Jacobsen S, Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis: Arthritis Rheum, 2003; 48(4); 955-62
29. Fukae J, Shimizu M, Kon Y, Screening for rheumatoid arthritis with finger joint power Doppler ultrasonography: Quantification of conventional power Doppler ultrasonographic scoring: Mod Rheumatol, 2009; 19(5); 502-6
30. Nesse W, Abbas F, van der Ploeg I, Periodontal inflamed surface area: Quantifying inflammatory burden: J Clin Periodontol, 2008; 35(8); 668-73
31. Eke PI, Page RC, Wei L, Update of the case definitions for population-based surveillance of periodontitis: J Periodontol, 2012; 83(12); 1449-54
32. Hoshino T, Kaneko N, Yoshihara A: Oral Health Prev Dent, 2023; 21; 339-46
33. Hirai K, Yamaguchi-Tomikawa T, Eguchi T: Front Immunol, 2020; 11; 1017
34. Silva DS, Costa F, Baptista IP, Evidence-based research on effectiveness of periodontal treatment in rheumatoid arthritis patients: A systematic review and meta-analysis: Arthritis Care Res (Hoboken), 2022; 74(10); 1723-35
35. de Pablo P, Serban S, Lopez-Oliva I, Outcomes of periodontal therapy in rheumatoid arthritis: The OPERA feasibility randomized trial: J Clin Periodontol, 2023; 50(3); 295-306
36. Arvikar SL, Collier DS, Fisher MC: Arthritis Res Ther, 2013; 15(5); R109
37. Chapman LS, Vinall-Collier K, Siddle HJ, ‘It surprised me a lot that there is a link’: A qualitative study of the acceptability of periodontal treatment for individuals at risk of rheumatoid arthritis: RMD Open, 2023; 9(2); e003099
38. Petit C, Culshaw S, Weiger R, Impact of treatment of rheumatoid arthritis on periodontal disease: A review: Mol Oral Microbiol, 2024; 39(4); 199-224
39. Yamashita M, Kobayashi T, Ito S, The periodontal inflamed surface area is associated with the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: A retrospective study: Mod Rheumatol, 2020; 30(6); 990-96
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