Abstract
Background:Fibromyalgia has been proposed to be driven by chronic inflammation and infections that are associated with early rheumatoid arthritis and inflammatory arthritis. Other than the central sensitization model, our knowledge of fibromyalgia pathogenesis has been expanded with an inflammation-dependent theory, which is stimulated by prolonged spinal cord hyperexcitability.Objectives:To determine the relationship between periodontitis and fibromyalgia.Methods:In this cohort study, 196,428 periodontitis patients and 196,428 propensity score-matched non-periodontitis controls were enrolled. A Cox proportional hazard model was utilized to estimate the risk of fibromyalgia and survival analysis was adopted to assess the time-dependent effect of periodontitis on fibromyalgia. Subgroup analyses stratified by age, gender, and follow-up years were conducted to identify susceptible populations. A symmetrical cohort was designed to ascertain the relationship between fibromyalgia and the risk of periodontitis.Results:Patients with history of periodontitis were more likely to develop fibromyalgia than non-periodontitis controls (HR =1.42, 95% CI =1.39–1.44, P < 0.001), which persisted in the survival analysis (log-rank test P < 0.0001). This effect was significant in both genders and all age subgroups, and was particularly evident in males (HR=1.52, 95% CI = 1.48–1.56, P < 0.001) and younger periodontitis patients (HR= 1.55, 95% CI =1.50-1.60, P < 0.001). Fibromyalgia patients who never had periodontitis presented with higher risk for periodontitis over time (HR = 1.43, 95% CI = 1.40 - 1.45, P < 0.001).Conclusion:This is the first longitudinal study that addresses the bidirectional relationship between fibromyalgia and periodontitis, in which periodontitis may serve as a risk factor or early sign of fibromyalgia. Based on the observed relationship between fibromyalgia and periodontitis, regular follow-ups and patient education are recommended for patients with either disease.Disclosure of Interests:None declared
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