Background and objectives Juvenile idiopathic arthritis (JIA), an autoimmune disease, has been proposed to be comorbid with obstructive sleep apnoea (OSA). We aimed at testing the hypothesis that patients with JIA may presented with high risk of OSA in a cohort study. Subjects and methods This is a cohort study including patients with JIA from 1999 to 2013 identified from a longitudinal health registry. A matched non-JIA control group was also included. The primary outcome variable was presence of OSA. A Cox proportional hazard model was developed to estimate the risk of OSA in patients with JIA. A cumulative probability model was adopted to assess the time-dependent effect of JIA on OSA development, implying a causal link of the association. Results A total of 2791 patients with JIA were included, and 11 164 individuals without JIA were selected as matched controls. A total of 95 included subjects had OSA: 31 in the JIA group and 64 in the control group. Patients with JIA were more likely to have OSA compared with controls (adjusted hazard ratio, aHR = 1.922, 95% confidence interval [CI] = 1.244–2.970). The incidence of developing OSA was particularly high among patients with JIA-associated deformity that presented at age 18–30 years (aHR = 1.993, 95% CI = 1.277–3.113) and males (aHR = 1.786, 95% CI = 1.097–2.906). The risk of developing OSA increased over 60 months (aHR = 2.523, 95% CI = 1.322–4.815) of follow-up after the JIA diagnosis. Conclusions Patients with JIA have a significantly increased risk of developing OSA compared with matched individuals without JIA.
ObjectiveTo identify the relationship between osteoarthritis and periodontitis.Methods144,788 periodontitis patients and 144,788 propensity score-matched controls without history of periodontitis were enrolled in this cohort study. A Cox proportional hazard model was used to estimate the risk of osteoarthritis. Survival analysis was utilized to assess the time-dependent effect of periodontitis on osteoarthritis. Age and gender were stratified to identify subgroups at risk. A symmetrical case-control analysis was designed to determine the relationship between present periodontitis and history of osteoarthritis.ResultsPatients with periodontitis had higher risk of osteoarthritis (hazard ratio, HR =1.15, 95% CI =1.12–1.17, p < 0.001) and severe osteoarthritis that led to total knee replacement or total hip replacement (TKR/THR) (HR =1.12, 95% CI =1.03–1.21, p < 0.01) than controls, which was time-dependent (log-rank test p < 0.01). The effect of periodontitis on osteoarthritis was significant in both genders and age subgroups over 30 years-old (all p < 0.001). Among them, females (HR=1.27, 95% CI = 1.13–1.42, p < 0.001) and patients aged over 51 (HR= 1.21, 95% CI =1.10-1.33, p < 0.001) with periodontitis were predisposed to severe osteoarthritis. In addition, periodontitis patients were more likely to have a history of osteoarthritis (odds ratio = 1.11, 95% CI = 1.06 - 1.17, p < 0.001).ConclusionsThese findings suggest an association between periodontitis and a higher risk of osteoarthritis, including severe osteoarthritis that led to TKR/THR. Likewise, periodontitis is more likely to develop following osteoarthritis. A bidirectional relationship between osteoarthritis and periodontitis was observed.
Background To determine whether patients who had undergone tonsillectomy would have higher risks of postoperative periodontitis. Methods Data were collected from the Taiwan Longitudinal Health Insurance Dataset from 1999 to 2013, a population‐based cohort study consisting of cases of newly‐onset sleep apnoea, chronic diseases of tonsils and adenoids, peritonsillar abscess, and periodontal diseases. A total of 1482 tonsillectomy cases and 14,796 non‐tonsillectomy controls were selected. Propensity score matching37 between the tonsillectomy group and the non‐tonsillectomy group was conducted to exclude the confounding effect resulting from indications of tonsillectomy. Cox proportional hazard model and subgroup analyses were conducted to identify subpopulations at risk of tonsillectomy‐associated periodontitis, and a sub‐outcome analysis was applied to identify the subtype of tonsillectomy‐associated periodontitis. Results A total of 648 patients who had undergone tonsillectomy and 648 out of 6509 propensity score‐matched controls were retrieved, among which 230 cases in the tonsillectomy group were associated with post‐surgical periodontitis (adjusted HR = 1.31, 95% CI = 1.08 to 1.59). The association persisted in a subpopulation of patients with periodontitis who received mechanical and surgical treatments for periodontitis (adjusted HR = 1.33, 95% CI = 1.09 to 1.63). The incidence of periodontitis was significantly high in the individuals who underwent tonsillectomy and was particularly high in those that were below 12 years of age (HR = 1.58, 95% CI = 1.10 to 2.27). The risk of periodontitis increased 4 years after tonsillectomy (HR = 1.82; 95% CI = 1.29 to 2.59). The majority of post‐tonsillectomy periodontitis was aggressive and acute periodontitis (HR = 1.37; 95% CI = 1.10 to 1.71). Conclusions Tonsillectomy performed in pediatric patients of < 12 years old, increased the risk of developing periodontitis. Aggressive and acute periodontitis as a long‐term, postoperative adverse event took place at 4 years or longer after tonsillectomy.
Oral lichen planus (OLP) is a common mucocutaneous, inflammatory disease, as prevalent as up to 1-2% of the population. It is most prevalent among females older than 40 years old with a male: female
Introduction Most craniofacial manifestations of neurofibromatosis type 1 (NF1) are considered as a result of tumor compression. We sought to determine salivary changes, caries, and periodontal complications in NF1 patients without tumors in the oral cavity. Objective and methods Eleven NF1 patients without tumors in the oral cavity and 29 matched controls without NF1 were enrolled in this case–control study. Demographic information, medical history, and data of intraoral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) scores and Russel’s periodontal index (PI), were recorded. The functional salivary analysis was performed for sialometry, salivary pH values, and amylase activity. Ingenuity Systems Pathway Analysis (IPA) was conducted to identify mutually activated pathways for NF1-associated oral complications. Results NF1 patients were associated with periodontitis (OR = 1.40, 95% CI = 1.06–1.73, P = 0.04), gingivitis (OR = 1.55, 95% CI = 1.09–2.01, P = 0.0002), and decreased salivary flow rates (OR = 1.40, 95% CI = 1.05–1.76, P = 0.005). Periodontal destruction, salivary changes, and dental caries in NF1 patients were age-dependent. Subgroup analyses based on age stratification suggested that salivary flow rates and salivary amylase activities were significantly low in NF1 patients aged over 20 years and that salivary pH values, PI and DMFT scores were significantly high among NF1- controls aged over 20. All oral complications were not significantly presented in NF1 patients aged below 20 years. IPA analyses suggested that cellular mechanisms underlying NF1-associated oral complications involved chronic inflammatory pathways and fibrosis signaling pathway. Conclusion NF1 patients without tumors in the oral cavity presented a comparatively high prevalence of age-dependent oral complications, including periodontal destruction and salivary gland dysfunction, which were associated with chronic inflammatory pathogenesis.
Background:Recently, osteoarthritis has been proposed to be driven by complement-mediated inflammatory cascades. That is, in addition to the conventional degenerative model, our knowledge of osteoarthritis pathogenesis has been expanded with an inflammation-dependent theory.Objectives:To identify the relationship between osteoarthritis and periodontitis.Methods:144,788 periodontitis patients and 144,788 propensity score-matched controls without history of periodontitis were enrolled in this cohort study. A Cox proportional hazard model was used to estimate the risk of osteoarthritis. Survival analysis was utilized to assess the time-dependent effect of periodontitis on osteoarthritis. Age and gender were stratified to identify susceptible subgroups. A symmetrical case-control analysis was designed to determine the relationship between periodontitis and history of osteoarthritis.Results:Patients with periodontitis had higher risk of osteoarthritis (HR =1.15, 95% CI =1.12–1.17, P < 0.001) and severe osteoarthritis that led to total knee/hip replacement (HR =1.12, 95% CI =1.03–1.21, P < 0.01) than controls, which was time-dependent (log-rank test P < 0.01). The effect of periodontitis on osteoarthritis was significant in both genders and age subgroups over 30 years old (all P < 0.001). Among them, females (HR=1.27, 95% CI = 1.13–1.42, P < 0.001) and patients aged over 51 (HR= 1.21, 95% CI =1.10-1.33, P < 0.001) with periodontitis were predisposed to severe osteoarthritis that led to total knee/hip replacement. In addition, periodontitis patients were more likely to have a history of osteoarthritis (OR = 1.11, 95% CI = 1.06 - 1.17, P < 0.001).Conclusion:These findings suggest a bidirectional relationship between osteoarthritis and periodontitis. Patients with periodontitis presented with a higher risk of osteoarthritis, including severe osteoarthritis that led to total knee/hip replacement. Likewise, periodontitis was more likely to develop following osteoarthritis.References:[1]Wang Q, Rozelle AL, Lepus CM, et al. Identification of a central role for complement in osteoarthritis. Nat Med 2011;17:1674-9. Temoin S, Chakaki A, Askari A, et al.[2]Identification of oral bacterial DNA in synovial fluid of patients with arthritis with native and failed prosthetic joints. J Clin Rheumatol 2012;18:117-21.Disclosure of Interests:None declared
Introduction: Craniofacial manifestations of neurofibromatosis type 1 (NF1) are considered as a result of tumor compression. We sought to determine age-dependent salivary changes, carious, and periodontal complications in NF1 patients without tumors in the oral cavity.Objective and methods: Eleven NF1 patients without tumors in the oral cavity and 29 matched controls without NF1 were enrolled in this case-control study. Demographic information, medical history, and data of intraoral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) scores and Russel’s periodontal index (PI), were recorded. The functional salivary analysis was performed for sialometry, salivary pH values, and amylase activity. Ingenuity Systems Pathway Analysis (IPA) was conducted to identify mutually activated pathways for NF1-associated oral complications.Results: NF1 patients were associated with periodontitis (OR=1.40, 95% CI=1.06-1.73, P = 0.04), gingivitis (OR=1.55, 95% CI=1.09-2.01, P = 0.0002), and decreased salivary flow rate (OR=1.40, 95% CI=1.05-1.76, P = 0.005). Periodontal destruction, salivary changes, and dental caries in NF1 patients were age dependent. Subgroup analyses based on age stratification suggested that salivary flow rates and salivary amylase activity were significantly lower among NF1 patients aged over 20 years and that salivary pH values, PI and DMFT scores were higher among NF1- controls aged over 20. All oral complications were not significantly presented among NF1 patients aged below 20. IPA analyses suggested that cellular mechanisms underlying NF1-associated oral complications involved chronic inflammatory pathways as well as fibrosis signalling pathway.Conclusion: NF1 patients without tumors in the oral cavity presented with a higher prevalence of age-dependent oral complications, including periodontal destruction and salivary gland dysfunction, which were associated with chronic inflammatory pathogenesis.
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