Bidirectional Relationship Between Osteoarthritis and Periodontitis: A Population-Based Cohort Study Over a 15-year Follow-Up

Abstract

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.

Long‐term safety and efficacy of methotrexate in patients with palindromic rheumatism

“…In most real-world studies on MTX for rheumatic diseases including rheumatoid arthritis, 2 ankylosing spondylitis, juvenile idiopathic arthritis, 3,4 Sjogren's syndrome, psoriasis, 5 osteoarthritis, 6 and fibromyalgia 7 , including the present study, 1 participants in most arms did not only receive MTX as a monotherapy. Instead, both groups took hydroxychloroquine (HCQ) at baseline.…”

“…4,5,6 Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 2 Department of Epidemiology, Harvard T.H. Chan School of…”

Effect of metabolic syndrome and obesity on the progression of knee osteoarthritis

“…2 That said, some points are worthy of further discussion.Occupational physical activity is an important risk factor for knee OA, which may be affected by the characteristics of residential areas in which the participants lived in. [3][4][5] As two-thirds of the participants in this study lived in rural areas, the homogeneity of lifestyle may lead to potential selection bias. Therefore, recommendations for future studies would include sensitivity analyses that determine whether characteristics of residential areas including walkability would affect the progression of knee OA.…”

“…6 As such, blood tests for metabolic syndrome collected at different follow-up timepoints, including at the end of the follow-up period, may provide more evidence for the interactions between metabolic changes and the progression of knee OA.Last but not least, participants with established knee OA were not excluded at baseline in the present study,1 while most cohort studies excluded patients with baseline OA to avoid residual confounders given the multifactorial etiology of both primary and secondary OA. 4,6,7,8,9 Overall, future studies that may expand the generalizability into more residential areas and more OA-involved joints, consider metabolic status in time-varying analyses, and preclude potential confounders, are warranted to elucidate the effect of metabolic syndrome on the progression of OA.…”

Generalizability of splint therapy for temporomandibular joint disorders in the era of precision medicine

“…Because the above‐mentioned diseases or treatments may result in TMJ overloading thus leading to structural changes in TMJ, 8 inclusion of these records may allow us to ascertain the safety and efficacy of splint therapies for TMJ disorders as a disease of multifactorial etiology. Likewise, future studies including patients with a history of TMJ‐involving diseases such as osteoarthritis, 9,10 rheumatoid arthritis, 11 or juvenile idiopathic arthritis 7,12 may allow for the generalization of splint therapies. On the other hand, further consideration of predictor variables of preferable clinical outcomes, including patient compliance to splint therapies or splint‐wearing behaviors and outcomes other than the Helkimo index that can indicate observable symptoms of TMJ disorders, 1 such as the visual analogue scale (VAS) and measures of quality of life, may augment our knowledge on the treatment outcomes of splint therapies more comprehensively.…”