Periodontal Disease as a Risk Factor for Rheumatoid Arthritis: A Systematic Review.

Abstract

Types of participants This review will consider for inclusion, studies that include patients with diagnosed rheumatoid arthritis with or without a clinical diagnosis of chronic periodontitis. Participants will be at least 45 years of age and both genders will be considered. The lower age limit was selected in order to be as inclusive as possible, however, studies specifically focussing aggressive forms of periodontitis will not be included as the aetiology is likely to be different. Studies were the focus is patients with co-morbidities that may impact on periodontal disease and/or rheumatoid arthritis will not be considered as they are outside the scope of this review. Diagnosis of periodontal disease should be based on the clinical and radiographic criteria described by the 1999 Consensus Classification of Periodontal Diseases. 19 Focus of the review The focus of this systematic review is the epidemiological association between periodontal disease and rheumatoid arthritis. Types of outcomes This review will consider studies that aim to establish periodontal disease as a risk factor for rheumatoid arthritis. Outcomes measures considered will include, but are not limited to: Primary Outcomes Studies that include either or both clinical and laboratory measurements that describe rheumatoid arthritis using criteria by the American College of Rheumatology 3 will be considered for inclusion. Outcomes measures such as DAS-28, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), citrullinated proteins (CCP) and rheumatoid factor (RF) will be considered. Secondary Outcomes A secondary outcome of interest in the tooth loss in rheumatoid arthritis sufferers as a result of periodontal disease.