Background Recent clinical-epidemiological data suggest that periodontitis (P) shows higher prevalence in patients with rheumatoid arthritis (RA). However, the strength of association is limited, with odds ratios (OR) ranging from 1,82–8,05. Meanwhile, prevalence of P in adult Spanish population1 varies from 16–30%,with smaller prevalence of severe P (5–11%). Nevertheless, there is no evidence of the P prevalence in RA patients in Spanish population.
Objectives 1.To describe the prevalence of P and its association with RA in patients located in our reference area. 2.To explain the characteristics of P in RA patients.
Methods Observational, descriptive, cross-sectional, case-control study of RA patients ≥18 years old (ACR/EULAR 2010) in a hospital Rheumatology Service, and a control group with a non-inflammatory joint disease, who had at least 4 teeth, had not received dental prophylaxis or antibiotic intake 6 months before study. Socio-demographic and anthropometric variables with smoking status, Graffar scale, stress level, annual dental prophylaxis, and co-morbidities such as osteoporosis (OP),diabetes mellitus (DM),dyslipidemia (DS),ischemic cardiovascular disease (ICD). Periodontal Variables: plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), recession (REC), clinical attachment level (CAL). Dental team: 2 periodontists/2 general dentists with inter-observer variability <30%. Full mouth CAL, PPD and periapical x-rays were taken. CAL was classified according to the European Workshop in 2005 (Tonetti), into level 0 (absence), N1T (mild), N2T (severe). Statistical Analysis: t-student, Kruskal Wallis, Chi-square. Statistical program: Stata 13.1.
Results 344 patients:187 RA (147 F/40 M) and 157 control (101F/56M). Both groups were comparable in age 54,9 (17,9), BMI 27,8 (4,6), stress level, DM and ICD. Differences in gender (>n° of males in controls), socioeconomic status (lower level in RA), >n° of current and former smokers RA (19,25%vs 8,92%/ 24,6%vs 11,46%),OP (23,45% RA vs 7,8%), DS (hipertrygliceridemia 11,23% RA vs 4,46%). There were182/187 (97, 33%) RA patients with P vs 104/157 (66,24%) patients with P in controls; N1T 52,41% RA vs 54,14%; N2T 44,92% RA vs 12,1% controls p<0,001, OR 18,55 (CI 95% 7,188–47,872),which is maintained after adjusting by confounding variables: OR 16,248 ± 9,295 (CI95% 5,295–49,858).Moreover, there was a poor periodontal status in RA patients with a dramatic increase in all periodontal parameters: PI, PPD, n° and percentage of PPD ≥5mm and BoP (p<0,001) compared with control group.
Conclusions 1.Our study shows a strong association between RA and P with an adjusted OR 16,25 2.RA patients presented an increased prevalence of severe P compared to controls with statistical significance, and estimated prevalence in Spanish population. 3. RA patients showed a more severe periodontitis than control patients.4. there were no differences in the prevalence of mild periodontitis between both groups.
Bravo-Pérez M C-PE. Encuesta de salud oral en España 2005. RCOE 11(4):409–56.
Disclosure of Interest None declared