Relationship between juvenile idiopathic arthritis and periodontal diseases

Abstract

Background: Juvenile idiopathic arthritis (JIA) is an arthritis of unknown etiology that begins before the 16th birthday and persists for at least six weeks with other known conditions excluded. In JIA, there is a destructive inflammatory process in the border between bone and connective tissue of the joint similar to the inflammatory process of the supporting tissue around the tooth in periodontitis. Objective: To emphasize the role of a pedo-dentist in the multidisciplinary management of JIA (to treat this detrimental disease before it becomes irreversible). Patients and Methods: A case-control study was conducted among JIA patients at Baghdad Teaching Hospital, Rheumatology Unit and private rheumatology clinic during the period September 2020 to May 2021. Twenty Iraqi patients diagnosed with JIA by rheumatologist (after fulfilling International League of Associations for Rheumatology (ILAR) criteria), compared with 20 healthy control individuals matched age. All patients were sent to specialized pediatric dental clinic in Baghdad where dental examination was applied. The examinations were conducted by two certified specialist pedo-dentist to indices Dental findings (dmf-s/DMF-S), Gingival inflammation (GI), Plaque index (PI). The surfaces of Ramfjord teeth were examined with diagnostic instruments (mirror and periodontal probe) and scored for all indices. Results: According to joint numbers involved, the polyarticular manner was the most common in 40% of patients, followed by oligoarticular in 35% of patients, and systematic manner in 20% of patients. In addition, one case presented with enthesitis related arthritis. The mean of gingival index (GI) in patients’ group (0.88±0.623) was higher than that of control group (0.61±0.53), without any significant difference (p=0.0545). However, the plaque index (PI) results showed high statistically significant difference (p=0.0162), similarly, the dmfs demonstrated a high significant difference (p=0.026) between patient and control groups. The DMFs was statistically significant (p=0.015), CRP level in relation to the indices, all indices have a significant high level association level (≥5mg/L) over normal level of CRP (<5 mg/L), effect of Prednisolone was statistically significant for GI (p=0.0245), and dmfs (p=0.0015). However, it was not significantly different in the value of PI (p=0.098), and DMFs (p=0.0627). In our study DMARDs (MTX) had a direct effect on GI and PI with a statistically significant difference (p=0.0164), and (p=0.017), respectively. Finally, the role of MTX on dmfs and DMFs was not significant. Conclusions: The indices used in this study to evaluate oral health in JIA children were GI has no significant difference compared to healthy children; PI was significantly higher compared to healthy children; the dmfs/DMFS both showed significantly higher compared to healthy children. The high CRP level has a significant association with GI, PI and dmfs, but no significant association with DMFs. Regarding the JIA treatment, Prednisolone has significantly modified all indices (in particular GI and DMFs), NSAIDs has significantly modified PI only, DMARDs (MTX) had direct effect on GI and PI, but no role on dmfs and no significant effect on DMFs.