The link between ankylosing spondylitis and oral health conditions: two nested case-control studies using data of the UK Biobank

Abstract

Ankylosing Spondylitis (AS) is an inflammatory rheumatic disease that affects the axial skeleton and the sacroiliac joints. Recent studies investigated the link between AS and oral diseases, particularly periodontitis. Others suggested that periodontitis may have a role in the pathogenesis of rheumatic diseases. Objective: The aim of this study is to investigate the association between AS and oral conditions. Material and Methods: This research was conducted using the UK Biobank Resource under Application Number 26307. The UK Biobank recruited around 500000 participants throughout Great Britain. Clinical records were available for 2734 participants. Two case-control studies were conducted based on whether AS was self-reported or clinically diagnosed. Oral conditions were identified using self-reported reports of oral ulcers, painful gums, bleeding gums, loose teeth, toothache, and dentures. The association between AS and oral conditions was assessed using logistic regression adjusted for age, gender, educational level, smoking status, alcohol consumption, and body mass index. Results: A total of 1307 cases and 491503 control participants were eligible for the self-reported AS study. The mean age was 58 years for the cases [7.5 standard deviation (SD)] and 57 years for the control groups (8.1 SD). Also, 37.1% of the cases and 54.2% of the control participants were females. Among the oral conditions, only oral ulcers were strongly associated with AS [1.57 adjusted odds ratio (OR); 95% confidence interval (CI) 1.31 to 1.88]. For the study of clinically diagnosed AS, 153 cases and 490351 control participants were identified. The mean age for both cases and control groups was 57 years; 7.6 SD for the cases and 8.1 for the control group. Females corresponded to 26.1% of the cases, and 54.2% of the control participants. Clinically diagnosed AS was associated with self-reported oral ulcers (2.17 adjusted OR; 95% CI 1.33 to 3.53). Conclusion: Self-reported and clinically diagnosed AS populations have increased risk of reporting oral ulcers. Further investigations are required to assess the link between a specific type of oral condition and AS.

Risk of autoimmune diseases in recurrent aphthous ulcer patients: A nationwide population study

“…Extra‐articular manifestations such as iritis, psoriasis, inflammatory bowel disease, and genitourinary tract inflammation may be associated as well (Braun & Sieper, 2007). Self‐reported and clinically diagnosed AS populations have increased risk of reporting oral ulcers (Abbood et al., 2018). The increased risk of chronic joint disease in RAS patients may be due to its rheumatic nature, but it could also be due to an adverse reaction to certain drugs, some of which are used to treat chronic arthritis, such as non‐steroidal anti‐inflammatory drugs and Methotrexate (Kalogirou et al., 2017).…”

Association Between Infections and Risk of Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

“…An additional 12 articles were excluded because they did not meet the inclusion criteria. Therefore, 13 articles that met the inclusion criteria were ultimately included (10,11,(17)(18)(19)(20)(22)(23)(24)(25)(26)(27)(28).…”

“…There were six case-control design articles (18,22,(25)(26)(27)(28) and seven cohort study design articles (10,11,17,19,20,23,24). It must be noted that one article involved two case-control studies (28). Therefore, we included 13 articles with 14 studies.…”

“…Numerous studies have investigated AS-related infections, including bacterial (10,17,18,22), viral (17,19,20,23), fungal (11), and those by microorganisms with sizes between those of bacteria and viruses (18,24,25). The infected sites include the respiratory (18,(24)(25)(26), immune (20,23,26,27), digestive (10,22,26,28), and genitourinary systems (19). However, there is no consensus on the association between infections and the risk of AS.…”

The Salivary Microbiota, Cytokines, and Metabolome in Patients with Ankylosing Spondylitis Are Altered and More Proinflammatory than Those in Healthy Controls

“…Patients with AS show a higher prevalence of periodontitis and poor oral hygiene than healthy controls ( 18 ), as well as a worse oral health-related quality of life ( 19 ). Furthermore, AS populations are reported to have an increased risk of reporting oral ulcers ( 20 ). The goal of the present study was to determine the alterations in the microbiota, immunity, and metabolism in the saliva of AS patients and to elucidate the role of these alterations in the occurrence and development of AS.…”