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Finally, the interconnectedness of these systems is highlighted by bibliometric analysis, which confirms the strong research focus on the relationship between periodontitis-related bacteria like P.g and systemic conditions like RA (Lin et al., 2025), and by the observation that drugs like Mesalazine, used for IBD, may modulate the oral-gut axis to treat periodontitis (Wang et al., 2025b)

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The safest approach is to restart at the lowest dose and titrate up, though this may not be practical for frequent alternating