Background Several observational studies have shown a high prevalence of periodontitis (PO) in patients with rheumatoid arthritis (RA) compared with the general population. Moreover, the presence of PO in RA was associated with higher disease activity according to some authors. Based on these studies, it has been postulated that the PO may be a risk factor for the onset and progression of RA.
Objectives 1. To estimate the prevalence of PO in RA patients from our hospital (RA-PO[+]); 2. To estimate severity of PO in RA patients; 3. To establish whether there were significant differences between median value of DAS28-ESR score between RA-PO[+] group versus PO[-] group; 4. To establish whether there were significant differences between the median value of HAQ score between RA-PO[+] group versus PO[-] group; 5. To establish whether there were significant differences between the median score of DAS28-ESR and HAQ between patients with and without PO receiving biological therapy.
Methods Patients diagnosed with RA (ACR/EULAR, 2010) from our hospital were prospectively included. Personal history, medication received (including biological therapy), presence or absence of rheumatoid factor (RF) and anti-citrullinated peptide antibody (anti-CCP) was recorded. The disease activity was assessed by DAS28- ESR and functional ability by HAQ questionnaire. The periodontal assessment was conducted by specialized dentists in immunosuppressed patients evaluating the presence and severity of PO. The median test was used to compare scores to describe the data and percentages were used in mean and SD, median and range according to the measurement scale of variables. For inferential measures, such measures with their corresponding confidence intervals were accompanied.
Results One hundred RA patients (94 women and 6 men) were included. The average age was 55.8 years (range 17-80 years) and the average time of evolution was 11.52 years (range 0-43 years). RF was available in 93 patients, being positive in 73 (78.5%) and anti-CCP was positive in 67 of 78 patients (85.9%). The prevalence of PO in RA patients was 44% [95%CI 34.20-54.26]; also, it was mild in 22% [95%CI 14.58-31.6], moderate in 14% [95%CI 8.14-22.71], severe 8% [95%CI 2.69-23.02]. There was no statistically significant difference in the mean value of DAS28-ESR score between the RA-PO[+] versus RA-PO[-] group (p=0.145). Furthermore, no statistically significant differences was found in HAQ value between RA-PO[+] versus RA-PO[-] group (p=0.22). In total, 24 patients were treated with biological therapy (infliximab=3; adalimumab=4; etanercept=11; abatacept=1; tocilizumab=4) and we did not observe statistically significant differences between the median score of DAS28-ESR and HAQ in patients with and without PO receiving this treatment (p=0.67).
Conclusions The prevalence of PO obtained in our study is higher than that estimated in the general population (<30%) and is consistent with other publications. Unlike other authors, there was no significant difference between the rate of RA activity and severity of PO. We also found no association between functional disability and advanced PO. In contrast to a recent publication, we did not observed lower response to treatment with biologic therapy in patients with PO.
Disclosure of Interest None declared