Activity of rheumatoid arthritis correlates with oral inflammatory burden

Abstract

To study oral health in patients with rheumatoid arthritis (RA) with emphasis on disease activity and treatment of RA. In this prospective cohort study 81 RA patients [53 early untreated RA (EURA) and 28 chronic RA (CRA) patients with inadequate response to synthetic disease modifying antirheumatic drugs (DMARDs)], underwent rheumatological [Disease Activity Score (28-joint) DAS28] and dental examinations [Total Dental Index (TDI), Decayed Missing Filled Teeth (DMFT) and Decayed Missing Filled Surfaces (DMFS)]. For controls, 43 volunteers were examined. After the examinations, EURA patients started treatment with synthetic DMARDs, oral and intra-articular glucocorticoids. CRA patients were candidates for biological DMARDs. The patients were re-examined mean 16 months later. Results were analyzed with descriptive statistics and logistic regression. TDI was higher in both RA groups at baseline compared to controls [EURA: 2 (2-3); CRA: 2 (1-3); controls 1 (1-3), p = 0.045]. DMFT [r 0.561 (p = 0.002)] and DMFS [r 0.581 (p = 0.001)] associated with DAS28 at baseline in CRA patients. After follow-up, DAS28 associated positively with DMFT [r 0.384 (p = 0.016)] and DMFS [r 0.334 (p = 0.038)] in EURA patients; as well as in CRA patients DMFT [r 0.672 (p = 0.001)], DMFS [r 0.650 (p = 0.001)]. RA patients already in the early phase of the disease had poorer oral health compared to controls. The caries indices associated with the activity of RA in both patient groups. Oral status may thus contribute to the development and further relate to the activity of RA.

Association Between Subjects with Newly Diagnosed Rheumatoid Arthritis and Dental Caries

“…The investigators included 53 untreated newly diagnosed rheumatoid arthritis patients (control group) and 28 chronic rheumatoid arthritis patients. The authors found a high frequency of caries in both groups, identifying a higher presence of xerostomia in patients with chronic RA (12). Some variables associated with the high frequency of dental caries in subjects with RA are:…”

“…Osteoarthritis in fingers and hands and 8. General osteoarthritis causing severe immobility in the patient (5)(6)(7)(8)(9)10,12,(31)(32)(33)(34).…”

“…Authors have reported that general and oral clinical manifestations are related to the evolution of RA. Nowadays it is accepted that early diagnosis and early treatment of Rheumatoid Arthritis can improve the prognosis in most of patients (2,12,13). Several researchers identified a high frequency of caries in recently diagnosed subjects and in subjects with several years of evolution of RA, however, in subjects with chronic RA was observed a high frequency of severe caries and an increase in tooth loss due to the presence of dental caries (12)(13)(14)(15).…”

“…Nowadays it is accepted that early diagnosis and early treatment of Rheumatoid Arthritis can improve the prognosis in most of patients (2,12,13). Several researchers identified a high frequency of caries in recently diagnosed subjects and in subjects with several years of evolution of RA, however, in subjects with chronic RA was observed a high frequency of severe caries and an increase in tooth loss due to the presence of dental caries (12)(13)(14)(15). Probably, the increase in the frequency of dental caries in recently diagnosed patients could explain the relationship between chronic RA and early tooth loss.…”

Associations between dental caries and systemic diseases: a scoping review

“…Also, S.mutans was significantly higher in RA patients and indices for oral inflammatory burden and disease were associated with serologic markers for RA. Furthermore, the oral inflammatory burden was significantly higher in early untreated RA when compared to chronic RA [ 82 ]. RA is a risk factor for both caries and periodontal disease [ 3 ].…”