Background Although rheumatoid arthritis (RA) is associated with periodontitis, it remains unclear whether periodontitis is a significant risk factor for RA.
Objectives To investigate RA risk based on a history of periodontitis.
Methods The study is a nationwide, population-based, case–control study using administrative data. We identified 13,779 newly-diagnosed RA cases (≥16 years) as the study cohort and 137,790 non-RA patients matched for age, sex, and initial diagnosis date (index date) as controls. Using multivariate logistic regression analysis after adjustment for potential confounders, including age; urbanization level; geographic region; length of medical history before the index date; and a history of diabetes, osteoporosis, and Sjögren’s syndrome, odds ratios (OR) with a 95% confidence interval (CI) were calculated to quantify the association between RA and periodontitis. External adjustment for smoking, a major unmeasured confounder, was performed. To evaluate the effect of periodontitis severity, and lag time since last periodontitis visit on the development of RA, ORs were calculated for subgroups of periodontitis patients according to the number of visits, cumulative cost, periodontal surgery, and time interval between last periodontitis visit and the index date.
Results An association between history of periodontitis and RA development (OR, 1.182; 95% CI, 1.140–1.225) was observed. The strength of this association remained statistically significant after adjustment for potential confounders (OR, 1.086; 95% CI, 1.047–1.127) and further adjustment for smoking using external information, or after variation of periodontal disease definitions. The association was dose- and time-dependent and was strongest when the interval between last periodontitis visit and the index date was.
Conclusions Periodontitis is not only a significant risk factor for RA with a dose–response relationship, but also a modest proximal risk factor for RA.
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Disclosure of Interest None Declared
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