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Background. Patients with systemic diseases have an increased risk of periodontitis, which is explained by both changes in the immune response and secondary effects on the microbiome. Many of them receive glucocorticoid therapy as a means of immunosuppression/anti-inflammatory action. Glucocorticoids have broad effects, ranging from immune modulation to tissue and metabolism effects, and there is growing evidence that they may affect the oral microbiota. Purpose – to evaluate the dynamics of dysbiotic changes in the periodontal micro- biome in patients with rheumatic diseases undergoing immunosuppressive therapy during comprehensive periodontal treatment. Materials and Methods. The study included 26 rheumatology patients (6 men and 20 women) aged 32–60 years: 18 individuals with periodontitis and 8 with intact periodontium. The observation period against the background of dental and immuno- suppressive therapy was 90 days. Microflora identification was performed using culture methods, phase-contrast microscopy, and biochemical test systems. Statistical analysis was performed using the Wilcoxon and McNemar criteria (p<0.05). Results. A structural transformation of the microbial community of the periodontium was established. An increase in the frequency of detection of C. albicans (from 38.46 to 50.0%), C. tropicalis (from 7.69 to 19.23%) and a consistently high level of C. krusei (15.38%) were recorded. Among aerobes, there was a tendency towards an increase in the proportion of E. coli (from 46.15 to 53.85%) and Enterobacter spp. (from 7.69 to 19.23%; p>0.05). A statistically significant result was the complete elimination of S. epidermidis (from 23.08 to 0%; p=0.031) and S. saprophyticus. The appearance of aggressive anaerobes was recorded: T. denticola (15.38%) and P. nigrescens (9.62%), which led to an expansion of the «red complex» (from 15.38 to 23.08%) against the background of the displacement of representatives of the «purple complex» (from 19.23 to 3.85%). Despite the deepening of dysbiosis, the number of patients with moderate and severe periodontitis decreased from 10 to 6. Conclusions. Long-term immunosuppressive therapy contributes to the intensification of dysbiotic changes and the appearance of periodontal pathogens of the «red» complex despite the treatment. However, a comprehensive dental approach allows achieving positive clinical dynamics of periodontal status in some patients.