Oral health-related quality of life in patients with early rheumatoid arthritis is associated with periodontal inflammation and painful temporomandibular disorders: a cross-sectional study

Johanna M Kroese,Johanna M Kroese,Johanna M Kroese,Corine M Visscher,Catherine M C Volgenant,Catherine M C Volgenant,Wim Crielaard,Laurette Van Boheemen,Corine M Visscher,Dirkjan Van Schaardenburg,Frank Lobbezoo,Frank Lobbezoo,Frank Lobbezoo,Wim Crielaard,Wim Crielaard,Maurits K A Van Selms,Bruno G Loos,Bruno G Loos,Bruno G Loos,Corine M Visscher

doi:10.1007/s00784-021-04034-z

Abstract

ObjectivesTo evaluate oral health-related quality of life (OHRQoL) in early rheumatoid arthritis (ERA) patients and individuals at risk of rheumatoid arthritis (RA) compared to healthy controls, and to explore possible associated factors.Materials and methodsFifty ERA patients, 50 at-risk individuals, and 50 age and gender matched healthy controls were recruited. OHRQoL (Oral Health Impact Profile-14 (OHIP-14)); number of decayed, missing, and filled teeth (DMFT); denture use; periodontal inflamed surface area (PISA); xerostomia (xerostomia inventory (XI)); and possible TMD (-pain) diagnoses were recorded. The groups were compared on these variables. Subsequently, backward multiple regression analyses were performed for the ERA and at-risk groups, with OHRQoL as the dependent variable and gender, age, DMFT, denture use, PISA, XI, non-painful TMD, and TMD pain as independent variables.ResultsAt-risk individuals had higher XI scores (U = 789.5, z = -3.181, p = 0.001, r = -0.32) and higher prevalence of TMD pain (p = 0.046, OR = 4.57; 95% CI 0.92–22.73) than healthy controls and higher OHIP-14 scores than the ERA group (U = 894.5, z = -2.418, p = 0.016, r = -0.24), while no difference in OHIP-14 was found between the control group and both other groups. For ERA patients, OHRQoL was associated with PISA and TMD pain (R2 = 0.498, p < 0.001). For at-risk individuals, OHRQoL was associated with XI score (R2 = 0.410, p < 0.001).ConclusionsAlertness of health professionals to TMD pain and periodontal inflammation in ERA patients and to xerostomia and TMD pain in at-risk individuals is recommended.Clinical relevanceThe results of this study address orofacial aspects that require attention of health professionals in the timeframe around RA onset.Trial registration: Dutch National Trial Register (NTR, NTR6362)

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints that causes pain and can result in functional disability and in lower health-related quality of life (HRQoL) [1]
Current literature describes an association between RA and several orofacial aspects, e.g., periodontitis, xerostomia, and temporomandibular disorders (TMD) [5,6,7,8]—all of which can negatively influence the oral health-related quality of life (OHRQoL) [9,10,11,12,13,14]
Our results indicate a positive effect of pharmacological treatment on oral hygiene, since five early rheumatoid arthritis (ERA) patients reported resolving of their difficulties with performing oral hygiene since the start of the pharmacological treatment for RA

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints that causes pain and can result in functional disability and in lower health-related quality of life (HRQoL) [1]. While HRQoL covers a broad scope, the OHRQoL (oral health-related quality of life) reflects the subjective perception of local orofacial conditions on quality of life [4]. Like HRQoL, OHRQoL is a valuable patient-reported outcome measure (PROM) that provides insight into subjective disease burden. Other orofacial aspects, e.g., the number of decayed, missing, and filled teeth (DMFT), and use of a denture, may affect OHRQoL [15]. Previous studies do show a lower OHRQoL in patients with RA compared to healthy controls, only limited data is available on the timeframe around RA onset [16]

Objectives

Results

Conclusion