Abstract
Background:Recently, osteoarthritis has been proposed to be driven by complement-mediated inflammatory cascades. That is, in addition to the conventional degenerative model, our knowledge of osteoarthritis pathogenesis has been expanded with an inflammation-dependent theory.Objectives:To identify the relationship between osteoarthritis and periodontitis.Methods:144,788 periodontitis patients and 144,788 propensity score-matched controls without history of periodontitis were enrolled in this cohort study. A Cox proportional hazard model was used to estimate the risk of osteoarthritis. Survival analysis was utilized to assess the time-dependent effect of periodontitis on osteoarthritis. Age and gender were stratified to identify susceptible subgroups. A symmetrical case-control analysis was designed to determine the relationship between periodontitis and history of osteoarthritis.Results:Patients with periodontitis had higher risk of osteoarthritis (HR =1.15, 95% CI =1.12–1.17, P < 0.001) and severe osteoarthritis that led to total knee/hip replacement (HR =1.12, 95% CI =1.03–1.21, P < 0.01) than controls, which was time-dependent (log-rank test P < 0.01). The effect of periodontitis on osteoarthritis was significant in both genders and age subgroups over 30 years old (all P < 0.001). Among them, females (HR=1.27, 95% CI = 1.13–1.42, P < 0.001) and patients aged over 51 (HR= 1.21, 95% CI =1.10-1.33, P < 0.001) with periodontitis were predisposed to severe osteoarthritis that led to total knee/hip replacement. In addition, periodontitis patients were more likely to have a history of osteoarthritis (OR = 1.11, 95% CI = 1.06 - 1.17, P < 0.001).Conclusion:These findings suggest a bidirectional relationship between osteoarthritis and periodontitis. Patients with periodontitis presented with a higher risk of osteoarthritis, including severe osteoarthritis that led to total knee/hip replacement. Likewise, periodontitis was more likely to develop following osteoarthritis.
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