Background Recent clinical data show a clear association between periodontitis (P) and rheumatoid arthritis (RA). However, the literature is inconsistent whether severity of P is associated with RA activity; some studies haven't shown any or negative association.Nevertheless, there is one study1 that has found a positive association between severity of P and activity of RA.
Objectives 1) To describe if the severity of P affects the clinical expression and activity of RA.2) To define the characteristics of P in RA patients with high clinical activity.
Methods Observational, cross-sectional, case-control study of adult RA patients (ACR/EULAR 2010) in a hospital Rheumatology Service,with at least 4 teeth, no dental prophylaxis or antibiotic intake 6 months before. Socio-demographic/anthropometric variables including smoking status, Graffar scale and stress level. RA variables: DAS28 (ESR & CRP), SDAI, titles RF/ACPA, extraarticular manifestations and comorbidities:o steoporosis (OP), diabetes mellitus (DM), dyslipidemia (DS), ischemic cardiovascular disease (ICD); glucocorticoid (GC),synthetic and biological therapy (DMARDs/BT). 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. 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), N 1T (mild), N2 T (severe). Statistical Analysis: t-student, Kruskal Wallis, Chi-square. Statistical program: Stata 13.1.
Results 187 RA patients, F/M 78,6%/21,4%, mean age 54,4 yo, follow-up: 8,8 y. Early RA 18,72%. Positive F/ACPA: 74,19%/67,86%. Mean clinical activity: DAS28(ESR) 3,81/DAS28(CRP) 3,18/SDAI 14,49. Disease activity: remission 20, 86%, low 24,06%, moderate 45,45%, high 9,63%; RA treatment: GC therapy 47,06% (pred 2,85 mg/d)l; DMARDs monotherapy/combined: 53%/11,76%, BT 30%. Smoking: Current smoker (19,25%)/former smoker (24,6%); low socioeconomic status (36,36%), relative poverty (33,69%); annual dental prophylaxis: 43%; dyslipidemia: 53,47%, OP/osteopenia: 55,86%. P N2T in 69, 05% of patients with moderate/high activity vs 30,95% remission/low activity; 55,34% patients with P N1T showed RA remission/low activity (p<0,001). It has been found a strong association between severe P and moderate/high RA activity, with OR 57,649±37,403 (CI 95% 16,163–205,620). Patients with moderate/high RA activity presented increased values of all periodontal parameters compared to those with low activity (p<0,005). It has been observed an association between rheumatoid nodes, pleuritis and OP with severe P (p=0,028).
Conclusions 1. High-activity RA is associated with severe P. 2. Patients with moderate and high activity RA have higher prevalence of both number and percentage of probing pocket depth ≥ de 5mm. 3. Presence of rheumatoid nodes and osteoporosis are related to severe P. 4. These results prompt an independent relationship between severe P and RA patients with high clinical disease activity.
Mikuls,et al. Arthritis Rheum 2014
Disclosure of Interest None declared