DOI QR코드

DOI QR Code

Associations of periodontal status in periodontitis and rheumatoid arthritis patients

  • Rovas, Adomas (Institute of Odontology, Faculty of Medicine, Vilnius University) ;
  • Puriene, Alina (Institute of Odontology, Faculty of Medicine, Vilnius University) ;
  • Punceviciene, Egle (Clinic of Rheumatology, Orthopedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University) ;
  • Butrimiene, Irena (Clinic of Rheumatology, Orthopedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University) ;
  • Stuopelyte, Kristina (Institute of Biosciences, Life Sciences Center, Vilnius University) ;
  • Jarmalaite, Sonata (Institute of Biosciences, Life Sciences Center, Vilnius University)
  • Received : 2020.09.24
  • Accepted : 2020.12.30
  • Published : 2021.04.30

Abstract

Purpose: The aim of this study was to assess the association between the clinical status of rheumatoid arthritis (RA) and periodontitis (PD) in patients diagnosed with PD and to evaluate the impact of RA treatment on the severity of PD. Methods: The study included 148 participants with PD, of whom 64 were also diagnosed with RA (PD+RA group), while 84 age-matched participants were rheumatologically healthy (PD-only group). PD severity was assessed by the following periodontal parameters: clinical attachment loss, probing pocket depth (PPD), bleeding on probing (BOP), alveolar bone loss, and number of missing teeth. RA disease characteristics and impact of disease were evaluated by the Disease Activity Score 28 using C-reactive protein, disease duration, RA treatment, the RA Impact of Disease tool, and the Health Assessment Questionnaire. Outcome variables were compared using parametric and non-parametric tests and associations were evaluated using regression analysis with the calculation of odds ratios (ORs). Results: Participants in the PD+RA group had higher mean PPD values (2.81 ± 0.59 mm vs. 2.58 ± 0.49 mm, P=0.009) and number of missing teeth (6.27±4.79 vs. 3.93±4.08, P=0.001) than those in the PD-only group. A significant association was found between mean PPD and RA (OR, 2.22; 95% CI, 1.16-4.31; P=0.016). Within the PD+RA group, moderate to severe periodontal disease was significantly more prevalent among participants with higher RA disease activity (P=0.042). The use of biologic disease-modifying antirheumatic drugs (bDMARDs) was associated with a lower BOP percentage (P=0.016). Conclusions: In patients with PD, RA was associated with a higher mean PPD and number of missing teeth. The severity of PD was affected by the RA disease clinical activity and by treatment with bDMARDs, which were associated with a significantly lower mean BOP percentage.

Keywords

Acknowledgement

The authors thank all the patients and their families. This project received funding from the European Regional Development Fund (project No. 01.2.2- LMT-K-718-01-0023) under a grant agreement with the Research Council of Lithuania (LMTLT).

References

  1. Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000 2014;64:57-80. https://doi.org/10.1111/prd.12002
  2. Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 2014;93:1045-53. https://doi.org/10.1177/0022034514552491
  3. Chapple IL. Time to take periodontitis seriously. BMJ 2014;348:g2645. https://doi.org/10.1136/bmj.g2645
  4. Slots J. Periodontitis: facts, fallacies and the future. Periodontol 2000 2017;75:7-23. https://doi.org/10.1111/prd.12221
  5. Cheng R, Wu Z, Li M, Shao M, Hu T. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review. Int J Oral Sci 2020;12:2. https://doi.org/10.1038/s41368-019-0068-8
  6. Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol 2015;15:30-44. https://doi.org/10.1038/nri3785
  7. Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 2018;6:15. https://doi.org/10.1038/s41413-018-0016-9
  8. Agnihotri R, Gaur S. Rheumatoid arthritis in the elderly and its relationship with periodontitis: a review. Geriatr Gerontol Int 2014;14:8-22. https://doi.org/10.1111/ggi.12062
  9. Valesini G, Gerardi MC, Iannuccelli C, Pacucci VA, Pendolino M, Shoenfeld Y. Citrullination and autoimmunity. Autoimmun Rev 2015;14:490-7. https://doi.org/10.1016/j.autrev.2015.01.013
  10. Perricone C, Ceccarelli F, Saccucci M, Di Carlo G, Bogdanos DP, Lucchetti R, et al. Porphyromonas gingivalis and rheumatoid arthritis. Curr Opin Rheumatol 2019;31:517-24. https://doi.org/10.1097/BOR.0000000000000638
  11. Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to mouth: a systematic review and meta-analysis of the association between rheumatoid arthritis and periodontitis. Front Immunol 2016;7:80.
  12. Rodriguez-Lozano B, Gonzalez-Febles J, Garnier-Rodriguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther 2019;21:27. https://doi.org/10.1186/s13075-019-1808-z
  13. Cosgarea R, Tristiu R, Dumitru RB, Arweiler NB, Rednic S, Sirbu CI, et al. Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis. Clin Oral Investig 2019;23:141-51. https://doi.org/10.1007/s00784-018-2420-3
  14. Kobayashi T, Kido JI, Ishihara Y, Omori K, Ito S, Matsuura T, et al. The KCNQ1 gene polymorphism as a shared genetic risk for rheumatoid arthritis and chronic periodontitis in Japanese adults: a pilot case-control study. J Periodontol 2018;89:315-24. https://doi.org/10.1002/JPER.17-0412
  15. Ziebolz D, Rupprecht A, Schmickler J, Bothmann L, Kramer J, Patschan D, et al. Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis: results from a cross-sectional study. J Periodontol 2018;89:1310-7. https://doi.org/10.1002/JPER.17-0616
  16. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81. https://doi.org/10.1002/art.27584
  17. Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol 2018;45 Suppl 20:S1-8. https://doi.org/10.1111/jcpe.12935
  18. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol 2018;89 Suppl 1:S159-72. https://doi.org/10.1002/JPER.18-0006
  19. Ryden L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, et al. Periodontitis increases the risk of a first myocardial infarction: a report from the PAROKRANK study. Circulation 2016;133:576-83. https://doi.org/10.1161/CIRCULATIONAHA.115.020324
  20. Ivanauskaite D, Lindh C, Rohlin M. Observer performance based on marginal bone tissue visibility in Scanora panoramic radiography and posterior bitewing radiography. Stomatologija 2008;10:36-43.
  21. van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol 2016;34:S40-4.
  22. Gossec L, Paternotte S, Aanerud GJ, Balanescu A, Boumpas DT, Carmona L, et al. Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative. Ann Rheum Dis 2011;70:935-42. https://doi.org/10.1136/ard.2010.142901
  23. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes 2003;1:20. https://doi.org/10.1186/1477-7525-1-20
  24. Perez-Chaparro PJ, McCulloch JA, Mamizuka EM, Moraes AD, Faveri M, Figueiredo LC, et al. Do different probing depths exhibit striking differences in microbial profiles? J Clin Periodontol 2018;45:26-37.
  25. Kim JH, Choi IA, Lee JY, Kim KH, Kim S, Koo KT, et al. Periodontal pathogens and the association between periodontitis and rheumatoid arthritis in Korean adults. J Periodontal Implant Sci 2018;48:347-59. https://doi.org/10.5051/jpis.2018.48.6.347
  26. Laugisch O, Wong A, Sroka A, Kantyka T, Koziel J, Neuhaus K, et al. Citrullination in the periodontium--a possible link between periodontitis and rheumatoid arthritis. Clin Oral Investig 2016;20:675-83. https://doi.org/10.1007/s00784-015-1556-7
  27. Quirke AM, Lugli EB, Wegner N, Hamilton BC, Charles P, Chowdhury M, et al. Heightened immune response to autocitrullinated Porphyromonas gingivalis peptidylarginine deiminase: a potential mechanism for breaching immunologic tolerance in rheumatoid arthritis. Ann Rheum Dis 2014;73:263-9. https://doi.org/10.1136/annrheumdis-2012-202726
  28. Haworth S, Shungin D, Kwak SY, Kim HY, West NX, Thomas SJ, et al. Tooth loss is a complex measure of oral disease: determinants and methodological considerations. Community Dent Oral Epidemiol 2018;46:555-62. https://doi.org/10.1111/cdoe.12391
  29. Kim JW, Park JB, Yim HW, Lee J, Kwok SK, Ju JH, et al. Rheumatoid arthritis is associated with early tooth loss: results from Korea National Health and Nutrition Examination Survey V to VI. Korean J Intern Med (Korean Assoc Intern Med) 2019;34:1381-91. https://doi.org/10.3904/kjim.2018.093
  30. Bingham CO 3rd, Moni M. Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Curr Opin Rheumatol 2013;25:345-53. https://doi.org/10.1097/BOR.0b013e32835fb8ec
  31. Hussain SB, Botelho J, Machado V, Zehra SA, Mendes JJ, Ciurtin C, et al. Is there a bidirectional association between rheumatoid arthritis and periodontitis? A systematic review and meta-analysis. Semin Arthritis Rheum 2020;50:414-22. https://doi.org/10.1016/j.semarthrit.2020.01.009
  32. Han JY, Reynolds MA. Effect of anti-rheumatic agents on periodontal parameters and biomarkers of inflammation: a systematic review and meta-analysis. J Periodontal Implant Sci 2012;42:3-12. https://doi.org/10.5051/jpis.2012.42.1.3
  33. Ayravainen L, Leirisalo-Repo M, Kuuliala A, Ahola K, Koivuniemi R, Meurman JH, et al. Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population. BMJ Open 2017;7:e011916. https://doi.org/10.1136/bmjopen-2016-011916
  34. Beeraka SS, Natarajan K, Patil R, Manne RK, Prathi VS, Kolaparthi VS. Clinical and radiological assessment of effects of long-term corticosteroid therapy on oral health. Dent Res J (Isfahan) 2013;10:666-73.

Cited by

  1. Impact of photodynamic therapy as an adjunct to non-surgical periodontal treatment on clinical and biochemical parameters among patients having mild rheumatoid arthritis with periodontitis vol.37, 2021, https://doi.org/10.1016/j.pdpdt.2021.102698