Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis: A Swedish Population Based Case-Control Study

Abstract

IntroductionThe possible hypothesis of a link between periodontitis and rheumatoid arthritis (RA), specifically anti-citrullinated protein antibody (ACPA) positive RA, prompted us to investigate the prevalence of periodontitis in the Swedish Epidemiological Investigation of RA (EIRA), a well-characterised population-based RA case-control cohort.MethodsPeriodontal status of 2,740 RA cases and 3,942 matched controls was retrieved through linking EIRA with the National Dental Health Registry (DHR), where dental diagnostic- and treatment codes on the adult Swedish population have been registered. Dental records from 100 cases and controls were reviewed to validate the periodontal diagnostic codes in DHR.ResultsThe reviewed dental records confirmed 90% of the periodontitis diagnoses in DHR among RA cases, and 88% among controls. We found the positive predictive value of periodontitis diagnoses in the DHR to be 89% (95% CI 78 to 95%) with a sensitivity of 77% (95% CI: 65 to 86%). In total, 86% of EIRA participants were identified in DHR. The risk for periodontitis increased by age and current smoking status in both cases as well as controls. No significant differences in prevalence of periodontal disease in terms of gingivitis, periodontitis, peri-implantitis or increased risk for periodontitis or peri-implantitis were observed between RA cases and controls. In addition, there was no difference on the basis of seropositivity, ACPA or rheumatoid factor (RF), among patients with RA.ConclusionsOur data verify that smoking and ageing are risk factors for periodontitis, both in RA and controls. We found no evidence of an increased prevalence of periodontitis in patients with established RA compared to healthy controls, and no differences based on ACPA or RF status among RA subjects.

Concentration of antibodies against Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis

“…Furthermore, citrullinated proteins have been detected in both rheumatoid joints and inflamed gingival tissue, as well as in other tissues in relation to inflammatory conditions [17–19]. However, an association between PD and established RA could not be confirmed in one of our recent publications [20]. …”

Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases

“…Individuals with rheumatoid arthritis have an increased risk of gingivitis and periodontitis (certainty low) and those with Sj€ ogren's syndrome appear to experience higher levels of periodontal diseases (certainty very low) (Antoniazzi et al 2009, Eriksson et al 2016, Fuggle et al 2016, Le Gall et al 2016). …”

Anti-phospholipid Antibodies and Smoking: An Overview

“…For rheumatoid arthritis, the association with periodontitis may be traced to the early 19th century, when Benjamin Rush (an American physician and politician) reported that total tooth eradication was a cure for Brheuma^; this Btreatment^was in use until the mid-20th century [87]. A 2016 review of dental records confirmed that 90 % of RA patients in the adult Swedish population had a diagnosis of periodontitis [88]; however, there was no significant difference in the prevalence of periodontitis in patients with established RA compared to healthy controls. Okida et al [89] showed that several periodontopathic bacteria were associated with RA, and Persson summarized evidence that associated these bacteria with RA [87].…”