Background The association between two chronic inflammatory diseases such as rheumatoid arthritis (RA) and periodontitis (PD) may be explained by causal and noncausal pathways. A possible mechanism in the increased PD observed in patients with RA is systemic bone loss due to the inflammatory process itself among others factors. Several studies have reported associations between OP and PD, not confirmed in other studies.
Objectives 1.To determine whether OP is associated with PD and with PD severity.
Methods Observational cross-sectional, case-control study of RA patients ≥18 y.o. meeting ACR/EULAR 2010 criteria for RA in a Rheumatology Dept. and a control group with a non-inflammatory joint disease, with at least 4 teeth, without dental prophylaxis or antibiotic intake 6 months before. Socio-demographic and anthropometric variables with smoking status,Graffar scale, stress level, annual dental prophylaxis, and co-morbidities such as diabetes mellitus (DM), dyslipidemia (DS), ischemic cardiovascular disease (ICD) and history of low-impact fractures. Dual-energy x-ray absorptiometry (DXA) (g/cm2) was performed with a DXA LUNAR (GE HealthCare) in lumbar spine and femoral neck. Periodontal Variables included plaque index, bleeding on probing, probing pocket depth, recession, clinical attachment level (CAL). Full mouth CAL and periapical x-rays were taken. CAL was classified according to the European Workshop in 2005 (Tonetti), into level 0 (absence), TL1 (mild), TL2 (severe). Statistical Analysis: t-student test, Kruskal Wallis, Chi-square with Stata 13.1.
Results We studied 344 patients: 187 RA (147 F/40 M) and 157control (101F/56M). Both groups were comparable in age 54.9 (17.9) y.o., body mass index 27.8 (4.6), stress level, DM and ICD. Differences in gender (>no. of males in controls), socioeconomic status (lower level in RA), >no. of current and former smokers RA (19.2%vs 8.9%/24.6%vs 11.5%),OP (23.4% RA vs 7.8%), DS (hipertrygliceridemia 11.2% RA vs 4.4%). PD was found in 97.3% of RA patients vs 66.2% of controls. DEXA was performed in 303 patients: 163 RA/140 controls that showed OP in 38 (23.3%) and 13 (9.3%) of RA and control groups as well as osteopenia in 47 (32.4%) and 16 (11.3%) respectively (p<0.001); 81% of these patients presented PD. There was association between PD and OP/osteopenia, so patients with PD had greater abnormal BMD 88% vs 76.3% with normal BMD; patients without PD showed greater normal BMD with statistically significant difference (23.7% vs 11.1%) (p=0.008).
Conclusions 1. PD was observed in 81% of the patients evaluated with BMD; of these, 89% had OP/ osteopenia, and among the patients without PD a significant normal BMD predominated. 2. PD was found in 97% of RA patients versus 66% of controls; similarly OP was present in 23.3% of RA patients versus 9.3% of controls, with the diference being significant. 3. There was no association between BMD and PD severity.
Disclosure of Interest None declared