Background There is a connection between periodontal disease (PD) and a higher incidence and severity of rheumatoid arthritis (RA) but to our knowledge there is no reported study evaluating the impact of PD in joint damage (JD). In our country, the prevalence of PD is 95%.
Objectives To demonstrate that a more severe PD is independently associated with higher Sharp/van der Heijde radiologic scores(Sharp VDH) in RA patients.
Methods A cross sectional study. All subjects met the ACR criteria for RA, had no other autoimmune disease and were older than 18 years at the diagnosis. We excluded patients with less than 4 teeth, serious or local ongoing infections, oral cancer or precancerous lesion, hospitalized, pregnant, or gingival hyperplasia induced by drugs. We applied a personal interview, physical examination, laboratory analysis and review of medical charts to assess factors associated with JD. Diagnosis and severity of PD were defined according to the American Academy of Periodontology criteria. Severity was categorized on the basis of the amount of clinical periodontal attachment loss (as mild, moderate or severe). All dental assessments and radiographs were interpreted by three odolontologist blinded to JD. A blinded investigator to clinical RA and PD status determined JD score according to Sharp VDH method. Statistical analysis: An univariated linear regression model to determine association between PD and JD was applied. Then, a multiple linear regression model adjusted for age, tobacco, gender, rheumatoid factor (RF), disease duration (DD), diagnosis delay, socioeconomic status (Graffar scale), disease activity (DAS 28CRP), functional status (MDHAQ) and comorbidities (Charlson index) was performed in order to determine persistence of the association. SPSSv16.0 statistical package was used.
Results 157 patients were evaluated, 88.5% were women, average (SD) age was 59.00 (12.73) years, DD: 17.60 (11.28) years, socioeconomic status were more frequent medium / medium low (34.4% and 30.6%), 89.2% were RF (+), the mean CRP: 12.78 (17.18) mg/L and the DAS28CRP: 3.94 (1.14). Erosion, joint narrowing space and total Sharp VDH score were 40.21 (48.28), 66.02 (43.85) and106.23 (89.12) respectively. 139 patients (88.5%) had PD, mostly moderate (54.1%). In multivariate analysis PD was independently associated with a higher score for erosion (B: 0.27, P = 0.002), joint space narrowing (B: 0.25, P = 0.003) and total SharpVDH scores (B: 0.27, P = 0.001).
Conclusions A more severe PD is associated with joint damage independently of other known associated factors. A more strict periodontal evaluation and follow-up could be useful for better outcomes with less disease progression in RA patients.
Disclosure of Interest None Declared