Abstract
This review identified papers that described periodontitis and rheumatoid arthritis in sub-Saharan Africa. Only English language publications from January 2010 to December 2017 describing original research in sub-Saharan Africa on the association between periodontitis and rheumatoid arthritis were considered for this study. Published databases: PubMed, Science direct and Google scholar, were searched using terms "periodontitis", "rheumatoid arthritis" and "Sub-Saharan Africa" to generate a set of putative studies. Articles with data on both rheumatoid arthritis and periodontitis compared to controls were selected. Studies on the association of periodontitis with cardiovascular disease, arthritis or rheumatoid arthritis alone were excluded. Data were extracted, critically appraised, and analyzed using a random-effect Mantel-Haenszel meta-analysis on plaque index, gingival index, pocket depth and clinical attachment loss. Three publications were selected for the systematic review and 2 for the meta-analysis. Two studies were from Sudan, and one was from Burina Faso. There was a significant increase in pocket depth (mean difference: 0.31; 95% CI: 0.21, 0.41; N= 274; (p ≤ 0.001) and clinical attachment loss (mean difference: 0.47; 95% CI: 0.22, 0.75; N= 274; (p ≤ 0.001) in participants with rheumatoid arthritis compared to normal controls. Findings from these combined studies show a significant relationship between periodontal disease and rheumatoid arthritis with increased periodontal pocket depth and clinical attachment loss. They also highlight the need for additional work especially in the area of associating rheumatoid arthritis with P. gingivalis, the oral microbiome and treating periodontal diseases to help in the management of rheumatoid arthritis.
Highlights
Periodontitis (PD) is characterized by destruction of both soft and hard tissue surrounding the teeth [1]
There was a significant increase in pocket depth (mean difference: 0.31; 95% CI: 0.21, 0.41; N = 274; (p ≤ 0.001)) and clinical attachment loss (mean difference: 0.47; 95% CI: 0.22, 0.75; N = 274; (p ≤ 0.001)) in participants with rheumatoid arthritis compared to normal controls
Studies looking at association of periodontal disease with the oral microbiome, cardiovascular disease, arthritis or rheumatoid arthritis alone were excluded from the study
Summary
Periodontitis (PD) is characterized by destruction of both soft and hard tissue surrounding the teeth [1]. The Porphyromonus gingivalis bacteria are thought to produce these citrullinated proteins with the aid of peptidyl-arginine-deiminases (PAD), enzymes that catalyze the conversion of peptidyl-arginine sections of proteins to peptidyl-citrulline This leads to loss of tolerance to neo-epitopes eliciting a response that may result in disease [7]. Conclusion: Findings from these combined studies show a significant relationship between periodontal disease and rheumatoid arthritis with increased periodontal pocket depth and clinical attachment loss.
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