Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population

Abstract

ObjectivesTo investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health.DesignProspective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16 months later. Controls were examined once.Settings and participantsThe study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) naїve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants.Outcome measuresDegree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria.ResultsModerate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth ≥4 mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results.ConclusionsModerate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.

Periodontitis and dental scaling associated with pyogenic liver abscess: A population‐based case‐control study

“…However, few studies have reported periodontitis to be a potential source of infection in PLA and no studies have confirmed the relationship between periodontitis and PLA . Our results indicated that exposure to periodontitis increased the risk of PLA (aOR = 2.31, 95% CI = 1.37‐3.90, P = .0018) in those aged 20‐49 years, which is similar to the results reported by Chen et al, who found that periodontitis could increase the risk of atrial fibrillation or flutter in patients, and those of Ayravainen et al, who confirmed that periodontitis increased the risk of rheumatoid arthritis.…”

Biological links in periodontitis and rheumatoid arthritis: Discovery via text‐mining PubMed abstracts

“…Both involve gene‐environment interaction, aberrant immune activation, and long‐standing chronic inflammation. A positive association of RA and PD is reported by a few epidemiologic studies . Shared risk factors such as smoking, older age, and HLA‐DRB1 genotype may explain this association in part.…”

Influence of plaque control on the relationship between rheumatoid arthritis and periodontal health status among Japanese rheumatoid arthritis patients

“…Various relationships have been reported between periodontitis and systemic diseases such as diabetes, cardiovascular disease, and stroke . Recent studies have suggested a bidirectional relationship between periodontal disease and rheumatoid arthritis (RA) …”

“…Therefore, the ability of RA patients to perform oral hygiene should be considered when investigating the pathogenic relationship between RA and periodontitis. A few case‐control studies have shown a significant association between RA and periodontitis after considering plaque control status, but others did not consider oral hygiene status as a factor . Another case‐control study initially found a significant association between juvenile idiopathic arthritis (JIA) and periodontal disease, but it disappeared after adjusting for the plaque index .…”

“…A few case-control studies have shown a significant association between RA and periodontitis after considering plaque control status, 13,14 but others did not consider oral hygiene status as a factor. 5,7,11 Another case-control study initially found a significant association between juvenile idiopathic arthritis (JIA) and periodontal disease, but it disappeared after adjusting for the plaque index. 17 Although there have been several case-control studies investigating the periodontal condition of patients with RA, there is limited information on oral hygiene and periodontal health among mild RA patients who have little or no difficulty performing routine oral hygiene tasks.…”