Periodontitis in rheumatoid arthritis patients, abundance and association with disease activity

Abstract

Background: There are some discrepancy in association between activity of rheumatoid arthritis (RA) and periodontitis. The aim of this study was to evaluate the periodontal status of outpatients with RA. Methods: The study was conducted in 2013-14 in a rheumatology clinic in Sari, north of Iran on 74 patients with RA. Evaluation of RA disease activity was according to disease activity score 28 (DAS28). Periodontitis was evaluated by probing depth (PD), gingival index (GI), clinical attachment level (CAL index), plaque index (PI), and panoramic X-ray. Statistical analysis included independent ttest and Mann-Whitney U test for quantitative, and chi square and OR for qualitative variables and evaluation of RA activity and periodontitis severity. Results: The mean±SD of age and disease duration were 47.01±8.1 and 8.93±8.6 years, respectively and the mean±SD number of teeth was 20.70±6.8. Twenty-seven (36.5%) patients had moderate to severe disease. Forty-seven cases (63.5%) were found with periodontitis and 14 (12.2%) were identified to have moderate to severe periodontitis, unrelated to disease activity (p=0.22). For active/inactive periodontitis OR =1.33 (95% CI: 0.46 - 3.87) was computed. There was no association between RA disease activity and number of teeth, CAL, PI, PD, and GI, (p>0.05). Conclusion: About 60% of RA patients suffered from periodontitis, but there was not any significant relation between RA disease activity and severity of periodontitis. Periodontitis may interfere with management and follow up of RA, so periodic periodontal examination is suggested in these patients.

Relationship between rheumatoid arthritis and periodontal disease in Korean adults: Data from the Sixth Korea National Health and Nutrition Examination Survey, 2013 to 2015

“…In the oral cavity, pathogenic bacteria can form clusters, which in turn leads to inflammation, thereby increasing the number of bacteria in the periodontal pocket. These changes lead to further inflammatory and immune‐mediated tissue changes, further environmental changes and tissue destruction, culminating in a predominance of periodontal pathogens and a greater degree of tissue damage . In this process, P. gingivalis is the most important strain causing periodontal disease and systemic inflammation .…”

“…These changes lead to further inflammatory and immune-mediated tissue changes, further environmental changes and tissue destruction, culminating in a predominance of periodontal pathogens and a greater degree of tissue damage. 22 In this process, P. gingivalis is the most important strain causing periodontal disease and systemic inflammation. 14 Previous studies have confirmed that P. gingivalis in aortic tissues, including vascular endothelial cells can cause inflammation characteristic of rheumatoid arthritis, arteriosclerosis, and myocardial infarction.…”

¿La periodontitis crónica modifica la morbilidad de la artritis reumatoide?: Aspectos clínicos y moleculares. Una revisión sistemática

“…La evidencia científica actual establece una asociación entre AR y PC. Específicamente se reporta una mayor prevalencia de PC en pacientes con diagnóstico de AR 19,22 y un mayor riesgo para el desarrollo de AR en pacientes con PC en comparación con la población general 23 . En este contexto, Mikuls et al 19 reportaron 35% de prevalencia de PC en pacientes con AR, mientras que Mobini et al 22 describen 63,5%.…”

“…Similares fueron los resultados de Lee et al 20 y Choi et al 21 , en los cuales la PC moderada fue observada en 61,7% y 61% de los pacientes con AR, respectivamente (p < 0,001). Estos resultados han sido confirmados recientemente en el estudio de Mobini et al 22 , donde 63,5% de los pacientes con AR padecía PC y 12,2% PC moderada-grave, siendo la PC más prevalente en AR en compara-ción con controles. Por otra parte, Chou et al 23 investigaron el riesgo de AR asociado a la exposición a PC en una cohorte compuesta por un millón de participantes seleccionados al azar durante el año 2010 en Taiwán.…”

“…Además, estos índices de inflamación y destrucción periodontal se correlacionan positivamente con la actividad de AR medida por DAS28 (p < 0,01) 25 . Sin embargo, existen estudios recientes en los que no se ha observado relación 22,26 . Según criterios ACR Correlación significativa entre títulos de anticuerpo contra P. gingivalis y valores de GI (p = 0,038), PPD (p = o,004), BOP (p = 0,004) y CAL (p = 0,002) en pacientes con AR Choi et al 21 observaron que BOP y GI se correlacionaron con la duración de la AR (p < 0,001), no así PPD y CAL, que no mostraron diferencias significativas.…”