Abstract
Rheumatoid arthritis (RA) is associated with increased risk of infections. Screening for oral (dental and/or sinus) infection could be proposed before biologic disease-modifying antirheumatic drugs (bDMARDs) initiation but is not systematically recommended. The aim of our study was to assess the prevalence of oral infection in RA patients requiring bDMARDs. This was a monocentric retrospective study. We included patients with RA and active disease requiring bDMARDs. Dental infection and sinusitis were assessed by a stomatologist and otorhinolaryngologist after clinical, panoramic dental X-ray and sinus CT evaluation. Factors associated with oral infections were analysed in uni- and multivariate models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). We included 223 RA patients (79.4% women, mean disease duration 8.9±8.6years). The mean age was 54.4±10.9years and mean Disease Activity Score in 28 joints 5.5±2.6. Systematic dental screening revealed infection requiring treatment before bDMARDs initiation in 46 (20.9%) patients. Sinusitis was diagnosed by the otorhinolaryngologist in 33 (14.8%) patients. Among the 223 patients, 69 (30.9%) had dental and/or sinus infection. On univariate analysis, active smoking was associated with increased probability of oral infection (OR=2.16 [95% CI 1.02-4.57], P=.038) and methotrexate with reduced probability (OR=0.43 [95% CI 0.23-0.81], P=.006). On multivariate analysis, no RA variables were associated with oral infection. In our study, asymptomatic oral infection was confirmed in one third of RA patients.
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