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Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case–control study
  1. Hsin-Hua Chen1,2,3,
  2. Nicole Huang2,
  3. Yi-Ming Chen1,2,
  4. Tzeng-Ji Chen2,3,4,
  5. Pesus Chou2,5,
  6. Ya-Ling Lee2,6,
  7. Yiing-Jenq Chou2,6,
  8. Joung-Liang Lan1,2,3,7,
  9. Kuo-Lung Lai1,
  10. Ching-Heng Lin8,
  11. Der-Yuan Chen1,2,3,7
  1. 1Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
  4. 4Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  5. 5Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taiwan
  6. 6Department of Dentistry, Taipei City Hospital-Heping Fuyou Branch, Taipei, Taiwan
  7. 7Institute of Biomedical Science, Chung-Hsing University, Taichung, Taiwan
  8. 8Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  1. Correspondence to Dr Der-Yuan Chen, Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, No 160, Section 3, Chung-Kang Road, Taichung 40705, Taiwan; dychen{at}


Objective To investigate the association between the risk of rheumatoid arthritis (RA) and a history of periodontitis.

Methods This nationwide, population-based, case–control study used administrative data to identify 13 779 newly diagnosed patients with RA (age ≥16 years) as the study group and 137 790 non-patients with RA matched for age, sex, and initial diagnosis date (index date) as controls. Using conditional logistic regression analysis after adjustment for potential confounders, including geographical region and a history of diabetes and Sjögren's syndrome, ORs with 95% CI were calculated to quantify the association between RA and periodontitis. To evaluate the effects of periodontitis severity and the lag time since the last periodontitis visit on RA development, ORs were calculated for subgroups of patients with periodontitis according to the number of visits, cumulative cost, periodontal surgery and time interval between the last periodontitis-related visit and the index date.

Results An association was found between a history of periodontitis and newly diagnosed RA (OR=1.16; 95% CI 1.13 to 1.21). The strength of this association remained statistically significant after adjustment for potential confounders (OR=1.16; 95% CI 1.12 to 1.20), and after variation of periodontitis definitions. The association was dose- and time-dependent and was strongest when the interval between the last periodontitis-related visit and the index date was <3 months (OR=1.64; 95% CI 1.49 to 1.79).

Conclusions This study demonstrates an association between periodontitis and incident RA. This association is weak and limited to lack of individual smoking status.

  • Rheumatoid Arthritis
  • Epidemiology
  • Infections

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