Ann Rheum Dis 71:1541-1544 doi:10.1136/annrheumdis-2011-200380
  • Clinical and epidemiological research
  • Concise report

Periodontal disease is significantly higher in non-smoking treatment-naive rheumatoid arthritis patients: results from a case-control study

  1. Narsimulu Gumdal1
  1. 1Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India
  2. 2Department of Periodontia, Government Dental College, Hyderabad, India
  1. Correspondence to Dr G Narsimulu, Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad 500082, India; narsimuluhyderabad{at}
  1. Contributors DP designed the study, and was actively involved in the collection and interpretation of the data, and manuscript draft preparation, KCD and SP were actively involved in the periodontal examination of rheumatoid arthritis patients and manuscript drafting. NG SA, LR and SK were involved in manuscript drafting, critical revision and statistical support and AK in laboratory support and manuscript drafting. All the authors revised and approved the final revised manuscript for submission.

  • Accepted 3 May 2012
  • Published Online First 8 August 2012


Objective To find the strength of association between periodontal disease (PD) and rheumatoid arthritis (RA) in non-smoking, disease modifying antirheumatic drug (DMARD)-naive RA patients in a case-control design.

Methods Patients of RA (DMARD-naive, non-smokers) satisfying the American college of Rheumatology 1987 criteria and healthy controls were included. PD was defined as present if the mean pocket depth (MPD) is ≥3 mm. Demographic data and disease specific variables were recorded for RA patients and healthy controls. Titres of immunoglobulin M-rheumatoid factor (IgM-RF) and anticitrullinated peptide antibodies (ACPAs) were measured using ELISA.

Results Patients with RA (n=91) had a 4.28 (CI 2.35 to 7.38) higher odds of PD (64.8% vs 28%, p<0.001) compared with healthy controls (n=93). The MPD was 3.61±1.22 mm in cases and 2.46±0.74 mm in controls (p<0.001). IgM-RF titres (110.56±95.81 vs 66.53±70.29; p=0.02) and ACPA titres (753.05±1088.27 vs 145.15±613.16, p=0.001) were significantly higher in RA patients with PD than those without PD. The MPD positively correlated with titres of ACPAs in RA patients (r=0.24; p=0.02).

Conclusions PD is more frequent and severe in non-smoking DMARD-naive RA patients compared with healthy controls. PD in RA is associated with high titres of ACPAs.


  • Funding Indian Council of Medical Research (ICMR).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Approval provide by the Ethical committee Board of the Nizam's Institute of Medical Sciences.

  • Provenance and peer review Not commissioned; externally peer reviewed.