Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case–control study

Chen, Hsin‐Hua; Huang, Nicole; Chen, Yi Ming; Chen, Tzeng Ji; Chou, Pesus; Lee, Ya-Ling; Chou, Yiing Jenq; Lan, Joung Liang; Lai, Kuo-Lung; Lin, Ching Heng; Chen, Der Yuan

doi:10.1136/annrheumdis-2012-201593

Cited by 159 publications

(173 citation statements)

References 41 publications

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“…NHANES-I and NHANES-III) with reported associations between certain periodontal parameters and rheumatoid arthritis [3,23 ■ ] may have underestimated periodontal disease prevalence [17 ■ ,18]. A recent report in Taiwanese rheumatoid arthritis patients confirmed earlier association studies [24 ■ ]. Even with their limitations, including their cross-sectional nature, variability in the dental endpoints reported, periodontal disease case definitions, extent of oral exams, limited information on rheumatoid arthritis disease characteristics or analysis of confounders, including steroid, and immunomodulatory drug use, the existing studies provide an overwhelming body of evidence to demonstrate that periodontal parameters including bleeding, gingivitis, and depth of tooth pockets are worse in rheumatoid arthritis patients [25].…”

Section: Association Studies Between Periodontal Disease and Rheumatomentioning

confidence: 60%

Periodontal disease and rheumatoid arthritis

Bingham

Moni

2013

Current Opinion in Rheumatology

141

106

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Purpose of review This review was conducted to focus on the recent clinical and translational research related to the associations between periodontal disease and rheumatoid arthritis. Recent findings There is a growing interest in the associations between oral health and autoimmune and inflammatory diseases. A number of epidemiologic studies have described associations between rheumatoid arthritis and periodontal disease. Recent clinical studies continue to support these reports, and are increasingly linked with biological assessments to better understand the nature of these relationships. A number of recent studies have evaluated the periopathogenic roles of Porphyromonas gingivalis, the oral microbiome, and mechanisms of site-specific and substrate-specific citrullination. These are helping to further elucidate the interactions between these two inflammatory disease processes. Summary Studies of clinical oral health parameters, the gingival microenvironment, autoantibodies and biomarkers, and rheumatoid arthritis disease activity measures are providing a better understanding of the potential mechanisms responsible for rheumatoid arthritis and periodontal disease associations. The cumulative results and ongoing studies have the promise to identify novel mechanisms and interventional strategies to improve patient outcomes for both conditions.

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Section: Association Studies Between Periodontal Disease and Rheumatomentioning

confidence: 60%

Periodontal disease and rheumatoid arthritis

Bingham

Moni

2013

Current Opinion in Rheumatology

141

106

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“…Without proper treatment, about half of these RA patients may lose their working capacity within ten years, making RA an important public health concern [21]. The NHI database has been proven to be a useful tool in revealing possible interactions between clinical risk factors and RA [22]. Considering the high prevalence of chronic HBV and HCV infections in Taiwan, we have a unique opportunity to clarify the debate over whether chronic hepatitis virus infection is associated with the development of RA.…”

Section: Introductionmentioning

confidence: 99%

Chronic Hepatitis C Virus Infection Is Associated with the Development of Rheumatoid Arthritis: A Nationwide Population-Based Study in Taiwan

Sung

et al. 2014

PLoS ONE

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ObjectiveThe association between chronic hepatitis virus infection and rheumatoid arthritis (RA) remains debatable. This nationwide population-based cohort study assessed the risk of RA among patients with a chronic infection of hepatitis B and/or C virus.Materials and MethodsWe used data extracted from the claims of 1,000,000 randomly sampled individuals covered under the Taiwan National Health Insurance program. Among the 49,892 persons identified in 2000–2010 with chronic hepatitis virus infection, 35,652 had chronic HBV infection alone, 10,253 had chronic HCV infection alone, and 3,987 had chronic HBV/HCV dual infections. The comparison cohort comprised 199,568 persons matched on sex, age and calendar year without chronic hepatitis virus infection. All study participants were free of RA at baseline and traced through 2011 with new RA cases identified.ResultsAfter adjusting for covariates, chronic HCV infection alone was significantly associated with an increased risk for RA (hazard ratio (HR) = 2.03, 95% confidence interval (CI) = 1.27–3.22). The increased risk for RA among participants with chronic HCV infection remained significant after restricting the analysis to those who were prescribed disease-modifying anti-rheumatic drugs. The corresponding HR for the overall sample was 1.89 (95% CI = 1.15–3.11). However, HBV carriers did not appear to be at a significantly higher risk for RA.ConclusionOur data imply that chronic HCV infection is associated with RA development.

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“…RA-related autoimmunity has been associated with tissue inflammation and injury at sites other than the joints. There is a consistent association between periodontal disease and RA [8, 31-33]. Porphyromonas gingivalis , a bacterium that causes periodontitis, may mediate citrullination of peptides and lead to the development of RA-related autoimmunity [34-36].…”

Section: Design and Methodsmentioning

confidence: 99%

Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study: Rationale and design for a randomized controlled trial evaluating rheumatoid arthritis risk education to first-degree relatives

Iversen

Kroouze

Mahmoud

et al. 2014

Contemporary Clinical Trials

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We present the rationale, design features, and protocol of the Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study (ClinicalTrials.gov NCT02046005). The PRE-RA Family Study is an NIH-funded prospective, randomized controlled trial designed to compare the willingness to change behaviors in first-degree relatives of rheumatoid arthritis (RA) patients without RA after exposure to RA risk educational programs. Consented subjects are randomized to receive education concerning their personalized RA risk based on demographics, RA-associated behaviors, genetics and biomarkers or to receive standard RA information. Four behavioral factors associated with RA risk were identified from prior studies for inclusion in the risk estimate: cigarette smoking, excess body weight, poor oral health, and low fish intake. Personalized RA risk information is presented through an online tool that collects data on an individual's specific age, gender, family history, and risk-related behaviors; presents genetic and biomarker results; displays relative and absolute risk of RA; and provides personalized feedback and education. The trial outcomes will be changes in willingness to alter behaviors from baseline to 6 weeks, 6 months, and 12 months in the three intervention groups. The design and execution of this trial that targets a special population at risk for RA, while incorporating varied risk factors into a single risk tool, offer distinct challenges. We provide the theoretical rationale for the PRE-RA Family Study and highlight particular design features of this trial that utilize personalized risk education as an intervention.

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Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case–control study

Abstract: This study demonstrates an association between periodontitis and incident RA. This association is weak and limited to lack of individual smoking status.

Cited by 159 publications

References 41 publications

Periodontal disease and rheumatoid arthritis

Periodontal disease and rheumatoid arthritis

Chronic Hepatitis C Virus Infection Is Associated with the Development of Rheumatoid Arthritis: A Nationwide Population-Based Study in Taiwan

Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study: Rationale and design for a randomized controlled trial evaluating rheumatoid arthritis risk education to first-degree relatives

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