DOI QR코드

DOI QR Code

Rheumatoid arthritis is associated with early tooth loss: results from Korea National Health and Nutrition Examination Survey V to VI

  • Kim, Ji-Won (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Jun-Beom (Departments of Periodontics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Yim, Hyeon Woo (Department of Preventive Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Jennifer (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kwok, Seung-Ki (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Ju, Ji Hyeon (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Wan-Uk (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Sung-Hwan (Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2018.03.02
  • Accepted : 2018.04.22
  • Published : 2019.11.01

Abstract

Background/aims: To examine the association between rheumatoid arthritis (RA) and periodontitis or tooth loss. Methods: The study used data from the fifth and sixth Korea National Health and Nutrition Examination Surveys conducted from 2010 to 2015. RA was defined as participant-reported physician-diagnosed RA that was being treated. Periodontitis and the number of natural teeth were determined by dental examination. Periodontitis was defined according to the community periodontal index (periodontal probing depth ≥ 4 mm). The association between RA and periodontitis or tooth loss was examined after controlling for confounding variables (e.g., age, smoking status, socioeconomic status, dental caries, frequency of toothbrushing, body mass index, alcohol consumption, and diabetes) in men and women. Subgroup analyses stratified by age were also performed. Results: The study enrolled 20,297 participants aged ≥ 19 years (157 RA patients and 20,140 non-RA controls). There was no association between RA and periodontitis or tooth loss in men and women. Subgroup analyses in those aged < 60 years revealed a non-significant association between RA and periodontitis (adjusted odds ratio, 1.53; p = 0.162), but they revealed a significant association between RA and tooth loss (adjusted β, 0.20; p = 0.042). Conclusions: RA was not associated with periodontitis, but was associated with tooth loss in younger adults. Younger RA patients are more likely to suffer tooth loss than general younger population; thus dental management is required.

Keywords

Acknowledgement

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI13C0016). Statistical consultation was supported by the Department of Bio-statistics of the Catholic Research Coordinating Center. We thank Mi Sun Park for her statistical support.

References

  1. Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 2012;83:1449-1454. https://doi.org/10.1902/jop.2012.110664
  2. Bingham CO 3rd, Moni M. Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol 2013;25:345-353. https://doi.org/10.1097/BOR.0b013e32835fb8ec
  3. Leech MT, Bartold PM. The association between rheumatoid arthritis and periodontitis. Best Pract Res Clin Rheumatol 2015;29:189-201. https://doi.org/10.1016/j.berh.2015.03.001
  4. Di Giuseppe D, Discacciati A, Orsini N, Wolk A. Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther 2014;16:R61. https://doi.org/10.1186/ar4498
  5. Eke PI, Wei L, Thornton-Evans GO, et al. Risk indicators for periodontitis in US adults: NHANES 2009 to 2012. J Periodontol 2016;87:1174-1185. https://doi.org/10.1902/jop.2016.160013
  6. Bonfil JJ, Dillier FL, Mercier P, et al. A "case control" study on the role of HLA DR4 in severe periodontitis and rapidly progressive periodontitis. Identification of types and subtypes using molecular biology (PCR.SSO). J Clin Periodontol 1999;26:77-84. https://doi.org/10.1034/j.1600-051X.1999.260203.x
  7. Schaefer AS, Jochens A, Dommisch H, et al. A large candidate-gene association study suggests genetic variants at IRF5 and PRDM1 to be associated with aggressive periodontitis. J Clin Periodontol 2014;41:1122-1131. https://doi.org/10.1111/jcpe.12314
  8. Ishida K, Kobayashi T, Ito S, et al. Interleukin-6 gene promoter methylation in rheumatoid arthritis and chronic periodontitis. J Periodontol 2012;83:917-925. https://doi.org/10.1902/jop.2011.110356
  9. Klareskog L, Stolt P, Lundberg K, et al. A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006;54:38-46. https://doi.org/10.1002/art.21575
  10. Scally SW, Petersen J, Law SC, et al. A molecular basis for the association of the HLA-DRB1 locus, citrullination, and rheumatoid arthritis. J Exp Med 2013;210:2569-2582. https://doi.org/10.1084/jem.20131241
  11. Mikuls TR, Payne JB, Yu F, et al. Periodontitis and Porphyromonas gingivalis in patients with rheumatoid arthritis. Arthritis Rheumatol 2014;66:1090-1100. https://doi.org/10.1002/art.38348
  12. Konig MF, Abusleme L, Reinholdt J, et al. Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Sci Transl Med 2016;8:369ra176. https://doi.org/10.1126/scitranslmed.aaj1921
  13. de Pablo P, Dietrich T, McAlindon TE. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol 2008;35:70-76.
  14. Chen HH, Huang N, Chen YM, et al. Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case-control study. Ann Rheum Dis 2013;72:1206-1211. https://doi.org/10.1136/annrheumdis-2012-201593
  15. Arkema EV, Karlson EW, Costenbader KH. A prospective study of periodontal disease and risk of rheumatoid arthritis. J Rheumatol 2010;37:1800-1804. https://doi.org/10.3899/jrheum.091398
  16. Demmer RT, Molitor JA, Jacobs DR Jr, Michalowicz BS. Periodontal disease, tooth loss and incident rheumatoid arthritis: results from the First National Health and Nutrition Examination Survey and its epidemiological follow-up study. J Clin Periodontol 2011;38:998-1006. https://doi.org/10.1111/j.1600-051X.2011.01776.x
  17. Eriksson K, Nise L, Kats A, et al. Prevalence of periodontitis in patients with established rheumatoid arthritis: a Swedish population based case-control study. PLoS One 2016;11:e0155956. https://doi.org/10.1371/journal.pone.0155956
  18. Han DH, Khang YH, Lee HJ. Association between adult height and tooth loss in a representative sample of Koreans. Community Dent Oral Epidemiol 2015;43:479-488. https://doi.org/10.1111/cdoe.12175
  19. Song IS, Han K, Ryu JJ, Park JB. Association between underweight and tooth loss among Korean adults. Sci Rep 2017;7:41524. https://doi.org/10.1038/srep41524
  20. Al-Shammari KF, Al-Khabbaz AK, Al-Ansari JM, Neiva R, Wang HL. Risk indicators for tooth loss due to periodontal disease. J Periodontol 2005;76:1910-1918. https://doi.org/10.1902/jop.2005.76.11.1910
  21. Musacchio E, Perissinotto E, Binotto P, et al. Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors. Acta Odontol Scand 2007;65:78-86. https://doi.org/10.1080/00016350601058069
  22. Jiang Y, Okoro CA, Oh J, Fuller DL. Sociodemographic and health-related risk factors associated with tooth loss among adults in Rhode Island. Prev Chronic Dis 2013;10:E45.
  23. Ando A, Ohsawa M, Yaegashi Y, et al. Factors related to tooth loss among community-dwelling middle-aged and elderly Japanese men. J Epidemiol 2013;23:301-306. https://doi.org/10.2188/jea.JE20120180
  24. Chapple IL, Bouchard P, Cagetti MG, et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017;44 Suppl 18:S39-S51. https://doi.org/10.1111/jcpe.12685
  25. Silvestre-Rangil J, Bagan L, Silvestre FJ, Bagan JV. Oral manifestations of rheumatoid arthritis. A cross-sectional study of 73 patients. Clin Oral Investig 2016;20:2575-2580. https://doi.org/10.1007/s00784-016-1745-z
  26. de Pablo P, Chapple IL, Buckley CD, Dietrich T. Periodontitis in systemic rheumatic diseases. Nat Rev Rheumatol 2009;5:218-224. https://doi.org/10.1038/nrrheum.2009.28
  27. Detert J, Pischon N, Burmester GR, Buttgereit F. The association between rheumatoid arthritis and periodontal disease. Arthritis Res Ther 2010;12:218. https://doi.org/10.1186/ar3106
  28. Stolt P, Bengtsson C, Nordmark B, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Ann Rheum Dis 2003;62:835-841. https://doi.org/10.1136/ard.62.9.835
  29. Eriksson K, Nise L, Alfredsson L, et al. Seropositivity combined with smoking is associated with increased prevalence of periodontitis in patients with rheumatoid arthritis. Ann Rheum Dis 2018;77:1236-1238.
  30. Linn-Rasker SP, van der Helm-van Mil AH, van Gaalen FA, et al. Smoking is a risk factor for anti-CCP antibodies only in rheumatoid arthritis patients who carry HLA-DRB1 shared epitope alleles. Ann Rheum Dis 2006;65:366-371. https://doi.org/10.1136/ard.2005.041079
  31. van der Helm-van Mil AH, Verpoort KN, le Cessie S, Huizinga TW, de Vries RR, Toes RE. The HLA-DRB1 shared epitope alleles differ in the interaction with smoking and predisposition to antibodies to cyclic citrullinated peptide. Arthritis Rheum 2007;56:425-432. https://doi.org/10.1002/art.22373
  32. Lee HS, Lee KW, Song GG, Kim HA, Kim SY, Bae SC. Increased susceptibility to rheumatoid arthritis in Koreans (가) heterozygous for HLA-DRB1*0405 and *0901. Arthritis Rheum 2004;50:3468-3475. https://doi.org/10.1002/art.20608
  33. Wegner N, Wait R, Sroka A, et al. Peptidylarginine deiminase from Porphyromonas gingivalis citrullinates human fibrinogen and α-enolase: implications for autoimmunity in rheumatoid arthritis. Arthritis Rheum 2010;62:2662-2672. https://doi.org/10.1002/art.27552
  34. Bombard JM, Powell KE, Martin LM, Helmick CG, Wilson WH. Validity and reliability of self-reported arthritis: Georgia senior centers, 2000-2001. Am J Prev Med 2005;28:251-258. https://doi.org/10.1016/j.amepre.2004.12.004
  35. Lo T, Parkinson L, Cunich M, Byles J. Discordance between self-reported arthritis and musculoskeletal signs and symptoms in older women. BMC Musculoskelet Disord 2016;17:494. https://doi.org/10.1186/s12891-016-1349-4
  36. Formica MK, McAlindon TE, Lash TL, Demissie S, Rosenberg L. Validity of self-reported rheumatoid arthritis in a large cohort: results from the Black Women's Health Study. Arthritis Care Res (Hoboken) 2010;62:235-241.
  37. Walitt BT, Constantinescu F, Katz JD, et al. Validation of self-report of rheumatoid arthritis and systemic lupus erythematosus: The Women's Health Initiative. J Rheumatol 2008;35:811-818.
  38. Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 2002;4 Suppl 3:S265-S272. https://doi.org/10.1186/ar578

Cited by

  1. Association Between Rheumatoid Arthritis and Periodontitis: Recent Progress vol.7, pp.2, 2020, https://doi.org/10.1007/s40496-020-00264-4
  2. rs2476601 in PTPN22 gene in rheumatoid arthritis and periodontitis—a possible interface? vol.18, pp.1, 2019, https://doi.org/10.1186/s12967-020-02548-w
  3. The association between rheumatoid arthritis and periodontal disease in a population-based cross-sectional case-control study vol.4, pp.1, 2019, https://doi.org/10.1186/s41927-020-00129-4
  4. Preterm birth associated with periodontal and dental indicators: a pilot case-control study in a developing country vol.34, pp.5, 2019, https://doi.org/10.1080/14767058.2019.1613363
  5. Is implant surgery a risk factor for osteonecrosis of the jaw in older adult patients with osteoporosis? A national cohort propensity score‐matched study vol.32, pp.4, 2019, https://doi.org/10.1111/clr.13713
  6. Elevated serum TREM-1 is associated with periodontitis and disease activity in rheumatoid arthritis vol.11, pp.1, 2019, https://doi.org/10.1038/s41598-021-82335-9