Periodontitis In Rheumatoid Arthritis Patients Research Articles

Increased risk of periodontitis in patients with rheumatoid arthritis: A nationwide register study in Norway.

To investigate the risk of periodontitis in rheumatoid arthritis (RA) patients in a nationwide register-based study. Patients and controls were defined using ICD-10 codes registered in the Norwegian Patient Registry (NPR), from 2011 to 2017. The 324,232 included subjects had at least one registered diagnostic code for RA (33,040 patients) or diagnostic codes for non-osteoporotic fractures or hip or knee replacement due to osteoarthritis (controls). The outcome was periodontitis, defined by codes for periodontal treatment from the Norwegian Control and Payment of Health Reimbursements Database (KUHR). Hazard ratios (HRs) were calculated for periodontitis in RA patients compared to controls. Generalized additive model in Cox regressions was estimated to visualize periodontitis occurrences as a function of number of RA visits. The risk of periodontitis increased with increasing number of RA visits. RA patients having 10 or more visits during the 7-year period had a 50% increased risk of periodontitis compared to controls (HR = 1.48, 95% confidence interval [CI]: 1.39-1.59); also, in patients with assumed new RA, an even higher risk estimate was seen (HR = 1.82, 95% CI: 1.53-2.17). In this register-based study in which periodontal treatment was used as a surrogate marker for periodontitis, we found an increased risk of periodontitis in RA patients, particularly those with active disease and new RA.

Prevalence of periodontitis in patients with rheumatoid arthritis

Background and Aim: Rheumatoid arthritis (RA) patients are more susceptible to the initiation of severe periodontitis which can ultimately intensify their systemic inflammation associated with RA. The present study aimed to determine the incidence of periodontitis in rheumatoid arthritis patients. Materials and Methodology: A cross-sectional analytical study was carried out on 168 rheumatoid arthritis patients in the Department of Dentistry and Internal Medicine of a Tertiary Care Hospital of Lahore, Pakistan from January 2022 to December 2022. All the patients were inquired about their demographic details, medical history and smoking habits. A detailed periodontal examination of full mouth was done and plaque index, clinical attachment level (CAL) and probing pocket depth (PPD) was measured. Rheumatoid factor (RF)’s presence, number of tender and swollen joints, erythrocyte sedimentation rate (ESR); Disease Activity Index (DAS) and hand radiographs were the different RA parameters which were recorded. Periodontal conditions were then associated and correlated with RA parameters. Results: Out of the total 168 RA patients, there were 142 (84.5%) females and 26 (15.5%) male patients. The overall mean age was 48.6 ± 8.64 years. The overall mean DAS score and disease duration was 4.58 ± 1.32 and 9.58 ± 6.8 years respectively.

Investigating the relationship between the severity of periodontitis and rheumatoid arthritis: a cross-sectional study.

This paper evaluates the prevalence and severity of periodontitis (PD) in patients with rheumatoid arthritis (RA), focusing on the link between the severity of PD with RA disease activity/disability scores, the influence of RA treatment on PD, and levels of vitamin D. A total of 93 RA patients were enrolled in the cross-sectional study and analyzed accordingly as RA-PD (N = 63, 67.8%) and RA-only (N = 30, 32.2%) groups. A number of associations between rheumatological clinical data, i.e., Disease Activity Score (DAS28 CRP), health assessment questionnaires, and PD severity (measured by periodontal outcome parameters) with regard to serum levels of vitamin D were assessed. The outcome variables were compared by parametric and non-parametric tests. A total of 29% of RA patients were diagnosed with severe PD. The RA-PD group presented a higher mean DAS28 CRP score in moderate-severe PD compared to periodontally healthy-initial stage PD subjects (4.49 ± 1.22 vs. 3.86 ± 1.58, p = 0.033). RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) were less likely to be diagnosed with PD (p = 0.022) and revealed significantly lower PD outcome parameters, i.e., bleeding on probing (%) and bone loss (%) (p < 0.05). Vitamin D concentration was significantly lower in RA-PD group with diagnosed advanced severe PD (IV stage) compared to moderate PD (II stage) (39.61 ± 17.12 vs. 52.07 ± 18.23 nmol/l, p = 0.031). The study revealed a high prevalence of severe PD in RA patients, being significantly associated with higher RA disease activity and lower vitamin D level in RA-PD group, while bDMARD treatment was related to lower PD outcome parameters. Key Points • Severe PD is prevalent amongst RA patients and is associated with RA disease activity. The higher RA DAS28 CRP score is associated with moderate-severe PD compared to periodontally healthy-initial stage PD in RA patients. • Biologic DMARDs treatment used for RA is linked to lower PD rates and PD outcome parameters. • Significantly lower vitamin D level is found in advanced severe PD compared to moderate PD stage in RA-PD subjects.

A patient-reported questionnaire developed in a German early arthritis cohort to assess periodontitis in patients with rheumatoid arthritis

BackgroundThe aim of this study was to develop a patient-reported questionnaire that is suitable to detect periodontitis (PD) in patients with rheumatoid arthritis (RA).MethodsA self-reported questionnaire containing 12 items potentially relevant to PD and dentists’ semiquantitative assessment of PD (no/mild/moderate/severe) was obtained from 353 patients from an early arthritis cohort. Available radiographs (n = 253) and blinded assessment of 3 independent dentists were used for validation. By defining the dentists’ assessment as the reference standard, relevant questionnaire items were identified with factor analysis methods. Receiver operator characteristic (ROC) plots were used to determine sensitivities and specificities to detect PD in varying severity. Ordinal regression models were used to determine the coefficients for the final score.ResultsSeventy percent had at least mild PD. The items from the questionnaire correlating best with the dentists’ assessment were selected for a final 6-item score (number of teeth, gum pockets, receding gums, loose teeth, receding jaw bone and tooth extractions and age). For the detection of any/moderate/severe PD, the bias-corrected areas under the curve (AUC) were 0.81/0.83/0.90. Sensitivity to detect mild PD was 85% and specificity 57%. Very high specificity was achieved for the detection of severe PD with 99% at the cost of low sensitivity (28%).ConclusionsThis patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings. We propose to use the score as a measure of periodontitis without applying cut-off values.

Clinical significance of periodontitis in rheumatoid arthritis patients: association with disease activity and functional status

Clinical significance of periodontitis in rheumatoid arthritis patients: association with disease activity and functional status

Distribution of Porphyromonas gingivalis fimA genotypes in patients affected by rheumatoid arthritis and periodontitis

Objective: To determine and compare the distribution of Porphyromonas gingivalis fimA genotypes in patients affected by Rheumatoid arthritis (RA) and periodontitis (PE).Materials and methods: This study involved 394 subjects divided into four groups, RA, PE, RA and PE and healthy subjects. PE was diagnosed by using clinical attachment loss (CAL) and probing depth (PD) indexes. Presence of P. gingivalis and its genotypes was identified by polymerase chain reaction in subgingival biofilm.Results: P. gingivalis was more frequent in patients with RA (82.69%), and fimA II genotype was the most frequent in all groups, especially in PE/RA (76.71%). There was statistical difference (p < .05) regarding the frequency of P. gingivalis genotypes such as fimA Ib, II and III.Conclusions: Distribution of P. gingivalis fimA II genotypes was different among groups, it could play a critical role in the presence of PE in RA patients.

Clinical Significance of Periodontitis in Rheumatoid Arthritis Patients: Association with Disease Activity and Functional Status

Objectives: To evaluate frequency of periodontitis (PD) in rheumatoid arthritis (RA) patients and relate it with clinical characteristics, disease activity, functional status, anti-cyclic citrullinated peptide (anti-CCP) and radiographic scores.Methods: The study included 60 RA patients and 30 controls. Clinical Disease activity index (CDAI), Modified Health Assessment Questionnaire (MHAQ), visual analogue scale of pain and Scott's modification to Larsen scoring method were assessed. Rheumatoid factor (RF) positivity and anti-CCP titer were measured. Periodontal examination was performed and relevant indices calculated.Results: The mean age of the patients was 49.1 ± 13 years and they were 52 females and 8 males. PD was present in 71.7% of RA patients versus 46.7% in control (p=0.02). PD was predominantly generalized (p=0.004) with moderate-severe degree (p=0.01). Age (p=0.007), disease duration (p<0.0001), morning stiffness (p=0.01), CDAI (p<0.0001), MHAQ (p=0.02), CRP (p=0.02), anti-CCP titer (p=0.01) and methotrexate treatment (p=0.005) were significantly higher in RA-PD versus RA. However, gender, smoking, oral hygiene, erythrocyte sedimentation rate, RF, anti-CCP positivity and radiographic scoring were insignificantly different. PD positivity was 96.3%, predominant generalized in 92.6%, moderate (40.7%) and severe degree (37%) in early RA versus (51.5%, 24.2%, 24.2%, 12.1% respectively) in late RA patients. All PD indices were higher in early patients (p ≤ 0.05) while teeth loss (p=0.03) was higher in late cases. CDAI, VAS and ACPA titer all significantly correlated with PD indices (p<0.05).Conclusion: Periodontitis is frequent in RA patients’ especially in early cases and is remarkably associated to disease activity and reduced functional status.

Periodontitis in rheumatoid arthritis patients, abundance and association with disease activity.

Background: There are some discrepancy in association between activity of rheumatoid arthritis (RA) and periodontitis. The aim of this study was to evaluate the periodontal status of outpatients with RA. Methods: The study was conducted in 2013-14 in a rheumatology clinic in Sari, north of Iran on 74 patients with RA. Evaluation of RA disease activity was according to disease activity score 28 (DAS28). Periodontitis was evaluated by probing depth (PD), gingival index (GI), clinical attachment level (CAL index), plaque index (PI), and panoramic X-ray. Statistical analysis included independent ttest and Mann-Whitney U test for quantitative, and chi square and OR for qualitative variables and evaluation of RA activity and periodontitis severity. Results: The mean±SD of age and disease duration were 47.01±8.1 and 8.93±8.6 years, respectively and the mean±SD number of teeth was 20.70±6.8. Twenty-seven (36.5%) patients had moderate to severe disease. Forty-seven cases (63.5%) were found with periodontitis and 14 (12.2%) were identified to have moderate to severe periodontitis, unrelated to disease activity (p=0.22). For active/inactive periodontitis OR =1.33 (95% CI: 0.46 - 3.87) was computed. There was no association between RA disease activity and number of teeth, CAL, PI, PD, and GI, (p>0.05). Conclusion: About 60% of RA patients suffered from periodontitis, but there was not any significant relation between RA disease activity and severity of periodontitis. Periodontitis may interfere with management and follow up of RA, so periodic periodontal examination is suggested in these patients.

A Possible Link Between Rheumatoid Arthritis and Periodontitis: A Systematic Review and Meta-analysis.

Previous studies have shown that patients with rheumatoid arthritis (RA) have a higher susceptibility to periodontitis, but the results of individual studies remain controversial. The aim of the present meta-analysis was to comprehensively evaluate the association between RA and periodontitis. A systematic literature search was conducted in PubMed and EMBASE. Data were extracted using standardized forms, and odds ratios (OR) with 95% confidence intervals (CI) were calculated for each study. Pooled data were estimated by fixed- and random-effects models if appropriate. Eight case-control studies were included in the present study. Study size ranged from 104 to 151,569 participants. The prevalence of periodontitis in RA patients ranged from 15.5% to 100%, compared with 10.0% to 82.1% in controls. In group 1 (control) and group 2, the heterogeneity was 38% and 11%, respectively. Using fixed-effects analysis, the overall pooled estimates of the ORs for periodontitis were 4.68 (95% CI: 3.11-7.05) and 1.28 (95% CI: 1.24-1.33) in groups 1 and 2, respectively. This meta-analysis indicates that RA was significantly associated with increased overall risk of periodontitis.

Study of chronic periodontitis in rheumatoid arthritis patients and its relation to serum anticitrulinated peptide antibody levels

Background Recently discovered evidence suggests that periodontitis might have a direct role in initiating and sustaining the immunoinflammatory responses in rheumatoid arthritis (RA), besides the risk factors that are common to both conditions. Aim The aim of this study was to determine the prevalence of chronic periodontitis in a cohort of Egyptian RA patients and their first-degree relatives and siblings compared with a control group and its relation to serum anticitrulinated peptide antibody (ACPA) levels. Patients and methods This study was carried out on three groups: group I included 100 patients with RA who fulfilled the 2010 ACR/EULAR classification criteria for RA and had less than 5 years’ disease duration. They were recruited from the Rheumatology Unit and Rheumatology Outpatient Clinic at Alexandria Main University Hospital. Group II included 50 first-degree relatives and siblings of RA patients who were free of clinical joint disease, and group III included 50 age-matched and sex-matched healthy subjects referred for general dental treatment at the Dental Clinic of Alexandria Main University Hospital. RA disease activity was assessed by applying Disease Activity Score 28, and the functional state of the patients was assessed by applying the Health Assessment Questionnaire. All subjects underwent a dental examination, including Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), Plaque Index (PI), and modified Gingival Index. The ACPA levels in serum were evaluated in group I, group II, and group III participants with periodontitis. Results Group I patients had significantly more periodontitis than group II (P Conclusion Our study shows an association between RA and chronic periodontitis. Individuals with RA are more likely to experience periodontitis.

Rheumatoid Arthritis and Periodontal Disease: A Rheumatologist's Perspective

Despite advances in our understanding of the in- flammatory events that underlie rheumatoid arthritis (RA), which have led to targeted therapies that more effectively control the condition, the etiology of RA is not fully under- stood. With the discovery that serum antibodies to citrullinated peptides (ACPA) are highly specific for RA and that Porphyromonas gingivalis, the major pathogen responsi- ble for periodontitis (PD), containsthe enzymeresponsible for the citrullination of peptides, a plausible explanation for ob- servations of increased incidence and severity of PD in RA patients and an appreciation of pathogenic similarities be- tween the two conditions has emerged. Studies of the effect of RA treatment on the severity of PD have been limited and conflicting, especially with respect to anti-TNF agents, but indicate the potential for IL-6 as a therapeutic target for both conditions. PD treatment appears to improve clinical and laboratory evidence of RA disease activity, and the response ofRAtoanti-TNFtherapyisabrogatedbythepresenceofPD. Thus, evaluation and treatment of PD can be recommended for all RA patients.

FRI0059 Evaluation of Periodontitis in 100 Patients with Rheumatoid Artrititis from Argentina

BackgroundSeveral observational studies have shown a high prevalence of periodontitis (PO) in patients with rheumatoid arthritis (RA) compared with the general population. Moreover, the presence of PO in RA was...

Periodontitis and Rheumatoid arthritis – A Review

The periodontal disease is an inflammatory condition of the supporting structres of the teeth. The presence of rheumatoid arthritis or other systemic inflammatory disease may increase the severity of the periodontal disease. The studies published in the past reveals that the oral bacterial infections and inflammation seemed to be linked directly to the etiopathogenesis of rheumatoid arthritis. There are findings support the impact of periodontal pathogens, such as Porpyromonas gingivalis on citrullination, and the association of periodontitis in rheumatoid arthritis patients with serospecificity toward rheumatoid factor and the anti-cyclic citrullinated peptide antibody 1 .In this review the common etiology, pathogenesis and immunogenetics of two

The association between rheumatoid arthritis and periodontal disease

Chronic, plaque-associated inflammation of the gingiva and the periodontium are among the most common oral diseases. Periodontitis (PD) is characterized by the inflammatory destruction of the periodontal attachment and alveolar bone, and its clinical appearance can be influenced by congenital as well as acquired factors. The existence of a rheumatic or other inflammatory systemic disease may promote PD in both its emergence and progress. However, there is evidence that PD maintains systemic diseases. Nevertheless, many mechanisms in the pathogenesis have not yet been examined sufficiently, so that a final explanatory model is still under discussion, and we hereby present arguments in favor of this. In this review, we also discuss in detail the fact that oral bacterial infections and inflammation seem to be linked directly to the etiopathogenesis of rheumatoid arthritis (RA). There are findings that support the hypothesis that oral infections play a role in RA pathogenesis. Of special importance are the impact of periodontal pathogens, such as Porphyromonas gingivalis on citrullination, and the association of PD in RA patients with seropositivity toward rheumatoid factor and the anti-cyclic citrullinated peptide antibody.