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Rak D, Kulloli AM, Shetty SK, Tripathy S, Mathur A, Mehta V, Cicciù M, Minervini G. Correlation between rheumatoid arthritis and chronic periodontitis: a systematic review and meta-analysis. Minerva Dent Oral Sci 2024; 73:294-302. [PMID: 38869834 DOI: 10.23736/s2724-6329.23.04891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The aim of this article is to summarize, compare, and assess possible association in individuals with or without rheumatoid arthritis (RA) for periodontitis. EVIDENCE ACQUISITION Three study repositories were searched for quantitative studies examining the relationship between periodontal disease and rheumatoid arthritis between 2000 and December 2022. Quality was evaluated using the Newcastle Ottawa Scale (NOS). The standardized mean difference (SMD), with a random effect model and a P value of 0.05 as the significance level, was utilized as a summary statistic measure. EVIDENCE SYNTHESIS Fourteen papers were included in the descriptive synthesis. Thirteen were qualified for meta-analysis. Our findings suggest a link between the two conditions in terms of clinical attachment levels (CAL), tooth loss, Plaque Index, and probing depth. The estimated SMD for CAL was found to be 0.68 (95% CI: 0.15-1.21) (P<0.01). For tooth loss, the forest plot analysis revealed an SMD of 1.62 (95% CI: 0.48-2.76) (P=0.005). Similarly, for pocket depth, the SMD was 0.53; CI: 0.07-0.99 (P>0.05). The pooled estimates for plaque index were 0.29; CI: 0.03-0.61 (P>0.05). The funnel plot showed a symmetric distribution with the absence of systematic heterogeneity. CONCLUSIONS Although our data suggest a link between periodontal disease and rheumatoid arthritis, larger population-based investigations are needed to validate this connection. Case-control studies must pave the way to more rigorous investigations with well-defined populations and clinical outcomes as primary outcome measures.
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Affiliation(s)
- Deepika Rak
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Anita M Kulloli
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Sharath K Shetty
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Snehasish Tripathy
- Department of Dental Research Cell, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Ankita Mathur
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Vini Mehta
- Department of Dental Research Cell, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India -
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
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Shim H, Koo J, Ahn J. Association between Rheumatoid Arthritis and Poor Self-Perceived Oral Health in Korean Adults. Healthcare (Basel) 2022; 10:healthcare10030427. [PMID: 35326903 PMCID: PMC8954365 DOI: 10.3390/healthcare10030427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objective: Rheumatoid arthritis (RA) and oral health problems have been reported as specific disease units; however, this study was conducted to evaluate the association between RA and comprehensive oral health status. Therefore, this study aimed to assess the association between RA and oral health using self-perceived oral health (SPOH) variables that can determine the oral health status in Korean adults using representative national data. Methods: Data from 40,186 selected participants were collected from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2018. The prevalence relative risk (PRR) was estimated using Poisson regression analysis to obtain the risk ratio of the SPOH according to RA. Results: The risk of SPOH depending on the RA status was statistically significant (odds ratio [OR] = 1.108, 95% confidence interval [CI] 1.005–1.222). In addition, the risk of SPOH depending on the RA status was higher in the group with diabetes mellitus (DM) (OR = 1.205, 95% CI 0.966–1.503) than in the group without DM (OR = 1.088, 95% CI 0.976–1.214). Conclusions: In this study, a significant association was identified between RA and SPOH. Oral health experts should identify the factors affecting the oral health of patients with RA and provide correct oral health care; however, additional research is needed.
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Affiliation(s)
- Hana Shim
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jungwan Koo
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (J.K.); (J.A.); Tel.: +82-2-2258-6268 (J.K.); +82-2-2258-6701 (J.A.); Fax: +82-2-2258-6678 (J.K. & J.A.)
| | - Joonho Ahn
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (J.K.); (J.A.); Tel.: +82-2-2258-6268 (J.K.); +82-2-2258-6701 (J.A.); Fax: +82-2-2258-6678 (J.K. & J.A.)
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González DA, Bianchi ML, Salgado PA, Armada M, Seni S, Isnardi CA, Citera G, Ferrary T, Orman B. Disease activity and subcutaneous nodules are associated to severe periodontitis in patients with rheumatoid arthritis. Rheumatol Int 2021; 42:1331-1339. [PMID: 34420067 DOI: 10.1007/s00296-021-04974-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/14/2021] [Indexed: 01/26/2023]
Abstract
Rheumatoid arthritis (RA) was significantly associated with increased overall risk of periodontitis, both chronic, inflammatory pathologies leading to connective tissue breakdown and bone destruction. To identify clinical and/or serological variables routinely evaluated during follow-up of people with RA which are associated with the severity of their periodontal disease. An observational, cross-sectional study was carried out, which included RA patients according to ACR/EULAR 2010 criteria having chronic periodontal disease. RA clinical parameters (disease duration, erythrocyte sedimentation rate, serum C-reactive protein, disease activity (DAS28) and rheumatoid factor, presence of bone erosions and rheumatic nodules) and also corticosteroid therapy were considered. Periodontitis was evaluated according to the American Academy of Periodontology (1999) and chronic periodontitis was assessed by full mouth periapical radiographic examination, periodontal probing depth, clinical attachment level and bleeding index. A total of 110 subjects with RA and chronic periodontitis were included. The female/male relation was 5.1, and no significant differences between genres were found in rheumatic or oral variables. RA patients with longer disease duration, higher disease activity and with rheumatic nodules had significantly greater periodontitis severity. Multivariate analysis confirmed that severe periodontitis was associated with DAS283 4.1 (OR 51.4, CI 95% 9.4-281.5) and the presence of rheumatic nodules (OR 6.4, CI 95% 1.3-31.6). Disease activity and rheumatic nodules were strongly associated with severe periodontitis. Based on these findings it would be desirable to include interdisciplinary management at an early stage of RA to ensure comprehensive treatment of both pathologies.
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Affiliation(s)
- Débora A González
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Biofísica y Bioestadística, Buenos Aires, Argentina
| | - María L Bianchi
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Medicina Interna, Buenos Aires, Argentina
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Pablo A Salgado
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Odontología Preventiva y Comunitaria, Buenos Aires, Argentina
| | - Mariana Armada
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Medicina Interna, Buenos Aires, Argentina
| | - Sabrina Seni
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Cirugía I, Buenos Aires, Argentina
| | | | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Teresita Ferrary
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Medicina Interna, Buenos Aires, Argentina
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Betina Orman
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina.
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The Effects of Prednisone/Ketoprofen Administration in Association with Amoxicillin Clavulanate Following Periodontal Surgical Therapy in Patients with Severe Chronic Periodontitis. ACTA ACUST UNITED AC 2021; 57:medicina57050447. [PMID: 34064493 PMCID: PMC8147920 DOI: 10.3390/medicina57050447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate and compare the effects of two different anti-inflammatory drugs (ketoprofen and prednisone) combined with an antibiotic (amoxicillin + clavulanic acid) and periodontal surgery on dental and periodontal parameters in patients with severe chronic periodontitis. In addition, salivary stress expressed by cortisol levels was assessed. Materials and Methods: An interventional study was performed on 22 periodontal subjects and 19 clinical healthy controls. The patients were divided in four groups, depending on treatment planning, as follows: eight patients received prednisone and antibiotherapy, associated with surgical periodontal therapy; seven patients received ketoprofen and antibiotherapy, associated with surgical periodontal therapy (group II); seven patients received only prednisone. Periodontal healthy patients underwent routine scaling and polishing. Bleeding on probing (BOP), dental mobility and salivary cortisol (ng/mL) were assessed before and after treatment. The means and standard deviations for the salivary cortisol levels (SCLs), dental and periodontal parameters were calculated for all groups using each patient as a unit of analysis. Results: Data analyses showed that the two different anti-inflammatory drugs associated with or without surgical therapy were efficient on inflammation periodontal parameters (BOP, dental mobility). Prednisone treatment alone was associated with a significant decrease of SCLs between pretreatment and post-treatment. Conclusions: In the present study, the effects of either of the anti-inflammatory drugs on inflammation evolution and salivary stress were comparable in patients undergoing antibiotherapy and surgical periodontal therapy.
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5
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Anusha D, Chaly PE, Junaid M, Nijesh JE, Shivashankar K, Sivasamy S. Efficacy of a mouthwash containing essential oils and curcumin as an adjunct to nonsurgical periodontal therapy among rheumatoid arthritis patients with chronic periodontitis: A randomized controlled trial. Indian J Dent Res 2019; 30:506-511. [PMID: 31745043 DOI: 10.4103/ijdr.ijdr_662_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study was to assess the efficacy of mouthwash containing essential oils and curcumin (MEC) as an adjunct to nonsurgical periodontal therapy on the disease activity of rheumatoid arthritis (RA) among RA patients with chronic periodontitis (CP). Materials and Methods A triple-blinded controlled trial was conducted among 45 female RA patients with CP randomized into three treatment groups as follows: Group A: scaling and root planing (SRP) with 0.2% chlorhexidine mouthwash as an adjunct (n = 15), Group B: SRP with MEC as an adjunct (n = 15), and Group C: SRP alone (n = 15). RA disease activity was assessed using erythrocyte sedimentation rate, serum C-reactive protein, serum anti-citrullinated protein antibody, and serum rheumatoid factor. Periodontal disease activity was assessed using plaque index, clinical attachment level (CAL), and pocket depth (PD). All parameters were recorded at baseline and 6 weeks thereafter. Data were assessed using one-way ANOVA and paired t-test. Results A significant reduction in periodontal and RA disease activity parameters was observed from baseline to 6 weeks following intervention (P < 0.05). The highest percentage of mean reduction in plaque index and RA parameters from baseline to 6 weeks was observed in Group B followed by Groups A and C. The highest percentage of mean reduction in PD and CAL was observed in Group A followed by Groups B and C (P < 0.001). Conclusion This study reveals that MEC as an adjunct to SRP is effective in reducing the disease activity of RA and CP, thereby warranting the use of the same.
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Affiliation(s)
- Divvi Anusha
- Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Pondicherry, Tamil Nadu, India
| | - Preetha Elizabeth Chaly
- Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Mohammed Junaid
- Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - J E Nijesh
- Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - K Shivashankar
- Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Pondicherry, Tamil Nadu, India
| | - Shyam Sivasamy
- Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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6
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Kordtabar S, Aghaie M, Fakhari E, Vakili MA. Periodontal Condition in Patients with Rheumatoid Arthritis: Effect of Anti-rheumatic Drugs. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:190-194. [PMID: 31579694 PMCID: PMC6732181 DOI: 10.30476/dentjods.2019.44914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem: Rheumatoid arthritis and periodontitis are chronic inflammatory diseases with a possible bidirectional relationship. This link may be affected by many factors like drug consumption.
Purpose: This study was designed to evaluate the periodontal condition in patients with rheumatoid arthritis, considering the effect of disease modifying anti-rheumatic drugs.
Materials and Method: This case-control study included 25 newly diagnosed rheumatoid arthritis patients with negative history of taking anti-rheumatic drugs, 25 patients who received anti-rheumatic drugs for more than three years and 50 healthy individuals as a control group. Periodontal indices, including plaque index, gingival index, probing depth, clinical attachment loss, and rheumatologic indices were recorded and compared between these groups.
Results: Rheumatoid arthritis patients were significantly more affected by periodontitis compared with healthy subjects (p= 0.006). There was no significant difference in rheumatologic
indices between patients with and without periodontitis. Clinical attachment loss in old rheumatoid arthritis patients and gingival index in newly diagnosed ones were significantly
more compared to the control group (p= 0.003 and p< 0.001 respectively). We could not find a linear relationship between the severity of rheumatoid
arthritis and chronic periodontitis (p= 0.1, r= -0.224).
Conclusion: Periodontitis and clinical attachment loss were more in patients with rheumatoid arthritis than the healthy group, especially in drug consumers. Gingival index in patients without
the history of consuming anti-rheumatic drugs was significantly higher than those who were drug consumers, indicating the effect of the medications on the signs of inflammation.
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Affiliation(s)
- Samira Kordtabar
- Dental student, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrdad Aghaie
- Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Fakhari
- Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Ali Vakili
- Health Management and Social Development Research Center, Dept. of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
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Kim JH, Choi IA, Lee JY, Kim KH, Kim S, Koo KT, Kim TI, Seol YJ, Ku Y, Rhyu IC, Song YW, Lee YM. Periodontal pathogens and the association between periodontitis and rheumatoid arthritis in Korean adults. J Periodontal Implant Sci 2018; 48:347-359. [PMID: 30619636 PMCID: PMC6312874 DOI: 10.5051/jpis.2018.48.6.347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose Periodontitis and rheumatoid arthritis (RA) share a similar inflammatory pathogenesis. Porphyromonas gingivalis (Pg) can induce anticyclic-citrullinated peptide autoantibodies (anti-CCP antibodies), a key factor in the development of RA. This study aimed at evaluating the relationships between the 2 diseases and identifying the clinical implications thereof, with a focus on periodontal pathogens in Korean adults. Methods A total of 260 RA patients and 86 age- and sex-matched control patients without arthritis were enrolled in this prospective cross-sectional study. Periodontal indices and the prevalence and amount of periodontal pathogens were compared between the groups. Correlations between periodontal and RA indices were examined, as were correlations between 9 periodontal pathogens and RA indices. Results The RA group had significantly higher values than the control group for all investigated periodontal indices (P<0.05) except the number of teeth. The gingival index (GI) was correlated with the disease activity score 28 (DAS28) (r=0.125, P=0.049), RA disease duration (r=0.253, P<0.001), erythrocyte sedimentation rate (ESR) (r=0.162, P=0.010), and anti-CCP antibody titer (r=0.205, P=0.004). Probing pocket depth (PPD) was correlated with ESR (r=0.139, P=0.027) and anti-Pg antibody titer (r=0.203, P=0.001). Bleeding on probing (BOP) was correlated with DAS28 (r=0.137, P=0.030), RA disease duration (r=0.202, P=0.001), ESR (r=0.136, P=0.030), anti-Pg antibody titer (r=0.177, P=0.005), and anti-CCP antibody titer (r=0.188, P=0.007). Clinical attachment level (CAL) and periodontitis severity were correlated with anti-Pg antibody titer (the former r=0.201, P=0.002; the latter r=0.175, P=0.006). The quantity of Pg was positively correlated with the serum anti-Pg antibody titer (r=0.148, P=0.020). Conclusions The GI, BOP, and PPD showed positive relationships with several RA indices. The anti-Pg antibody titer had positive relationships with PPD, BOP, CAL, and periodontitis severity. Thus, increasing values of periodontal indices could be used as a risk indicator of disease development in RA patients, and an increasing anti-Pg antibody titer could be considered as a warning sign in RA patients suffering with periodontitis.
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Affiliation(s)
- Jin-Hee Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea
| | - In Ah Choi
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Joo Youn Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Kyoung-Hwa Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yang-Jo Seol
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Young Ku
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - In-Chul Rhyu
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Moo Lee
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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8
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Jung ES, Choi YY, Lee KH. Relationship between rheumatoid arthritis and periodontal disease in Korean adults: Data from the Sixth Korea National Health and Nutrition Examination Survey, 2013 to 2015. J Periodontol 2018; 90:350-357. [DOI: 10.1002/jper.18-0290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Eun Seo Jung
- Department of Dental HygieneCollege of Bioecological HealthShinhan University Uijeongbu Republic of Korea
| | - Yoon Young Choi
- Department of Dental HygieneCollege of Bioecological HealthShinhan University Uijeongbu Republic of Korea
| | - Kyeong Hee Lee
- Department of Dental HygieneCollege of Bioecological HealthShinhan University Uijeongbu Republic of Korea
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9
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Bender P, Egger A, Westermann M, Taudte N, Sculean A, Potempa J, Möller B, Buchholz M, Eick S. Expression of human and Porphyromonas gingivalis glutaminyl cyclases in periodontitis and rheumatoid arthritis-A pilot study. Arch Oral Biol 2018; 97:223-230. [PMID: 30399509 DOI: 10.1016/j.archoralbio.2018.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Human glutaminyl cyclases (QC and isoQC) play an important role in maintaining inflammatory conditions. Meanwhile a glutaminyl cyclase synthesized by Porphyromonas gingivalis (PgQC), a key pathogen in developing periodontitis and a potential link of periodontitis with rheumatoid arthritis (RA), was discovered. This study was aimed to determine the expression of QC, isoQC and PgQC in patients with chronic periodontitis (CP) and RA. DESIGN Thirty volunteers were enrolled in a pilot study and divided into 3 groups (healthy, CP and RA individuals). Blood samples, biofilm and gingival crevicular fluid (GCF) were analysed for mRNA expression of QC, isoQC and P. gingivalis QC. Major bacteria being associated with periodontal disease were quantified in subgingival biofilm and protein levels for monocyte chemoattractant protein (MCP)-1, MCP-3 and interleukin (IL)-1β) were determined in the GCF. Expression of PgQC on the mRNA and protein levels was assessed in two P. gingivalis strains. RESULTS PgQC is expressed in P. gingivalis strains and the protein seems to be located mainly in peri-plasmatic space. mRNA expression of QC was significantly increased in the peripheral blood from RA patients vs. healthy subjects and CP patients (p = 0.013 and p = 0.003, respectively). In GCF of RA patients, QC mRNA was detected more frequently than in healthy controls (p = 0.043). In these samples IL-1β levels were also elevated compared to GCF from periodontally healthy individuals (p = 0.003). PgQC was detected in eight out of the 13 P. gingivalis positive biofilm samples. CONCLUSION Activity of QC may play a supportive role in maintaining chronic periodontal inflammation and destruction in RA. PgQC is expressed in vivo but further research is needed to evaluate biological importance of this enzyme and if it constitutes a potential target in periodontal antimicrobial therapy.
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Affiliation(s)
- Philip Bender
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andreas Egger
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Martin Westermann
- Center of Electron Microscopy, University Hospital of Jena, Jena, Germany
| | - Nadine Taudte
- Fraunhofer Institute for Cell Therapy and Immunology IZI-MWT, Halle/Saale, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University Krakow, Krakow, Poland; Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, USA
| | - Burkhard Möller
- Department of Rheumatology, Clinical Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
| | - Mirko Buchholz
- Fraunhofer Institute for Cell Therapy and Immunology IZI-MWT, Halle/Saale, Germany
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
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10
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Li R, Tian C, Postlethwaite A, Jiao Y, Garcia-Godoy F, Pattanaik D, Wei D, Gu W, Li J. Rheumatoid arthritis and periodontal disease: What are the similarities and differences? Int J Rheum Dis 2018; 20:1887-1901. [DOI: 10.1111/1756-185x.13240] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rongbin Li
- Center of Integrative Research; The First Hospital of Qiqihaer City; Qiqihaer Heilongjiang China
- Department of Orthopedic Surgery and BME-Campbell Clinic; University of Tennessee Health Science Center; Memphis TN USA
| | - Cheng Tian
- Department of Orthopedic Surgery and BME-Campbell Clinic; University of Tennessee Health Science Center; Memphis TN USA
| | - Arnold Postlethwaite
- Division of Connective Tissue Diseases; Department of Medicine; University of Tennessee Health Science Center; Memphis TN USA
- Department of Veterans Affairs Medical Center; University of Tennessee Health Science Center; Memphis TN USA
| | - Yan Jiao
- Department of Orthopedic Surgery and BME-Campbell Clinic; University of Tennessee Health Science Center; Memphis TN USA
| | - Franklin Garcia-Godoy
- Bioscience Research Center; College of Dentistry; University of Tennessee Health Science Center; Memphis TN USA
| | - Debendra Pattanaik
- Division of Connective Tissue Diseases; Department of Medicine; University of Tennessee Health Science Center; Memphis TN USA
- Department of Veterans Affairs Medical Center; University of Tennessee Health Science Center; Memphis TN USA
| | - Dongmei Wei
- Center of Integrative Research; The First Hospital of Qiqihaer City; Qiqihaer Heilongjiang China
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic; University of Tennessee Health Science Center; Memphis TN USA
- Department of Veterans Affairs Medical Center; University of Tennessee Health Science Center; Memphis TN USA
| | - Jianwei Li
- Center of Integrative Research; The First Hospital of Qiqihaer City; Qiqihaer Heilongjiang China
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11
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Rothschild B. Correlation of Periodontal Disease With Inflammatory Arthritis in the Time Before Modern Medical Intervention. J Periodontol 2016; 88:266-272. [PMID: 27834119 DOI: 10.1902/jop.2016.160422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Controversy exists regarding possible correlation of periodontal disease with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Confounding factors may relate to stringency of inflammatory disease diagnosis and the effect of therapeutic intervention for RA on periodontal disease. These factors are investigated in this study. METHODS Forty-five individuals with documented RA (n = 15), spondyloarthropathy (n = 15), and calcium pyrophosphate deposition disease (CPPD) (n = 15), from the Hamann-Todd collection of human skeletons compiled from 1912 to 1938, and 15 individuals contemporarily incorporated in the collection were examined for tooth loss, cavity occurrence, average and maximum lingual and buccal depth of space between tooth and bone, periosteal reaction, serpentine bone resorption, abscess formation, and root penetration of the bone surface and analyzed by analysis of variance. RESULTS Tooth loss was common, but actual number of teeth lost, cavity occurrence, average and maximum lingual and buccal depth of space between tooth and bone, periosteal reaction, serpentine grooving surrounding teeth (considered a sign of inflammation), abscess formation, and root exposure (penetration of bone surface) were indistinguishable among controls and individuals with RA, spondyloarthropathy, and CPPD. CONCLUSIONS Although many factors can affect periodontal disease, presence of inflammatory arthritis does not appear to be one of them. The implication is that dental disease was common in the general population and not necessarily associated with arthritis, at least before the advent of modern rheumatologic medications. As specific diagnosis did not affect prevalence, perhaps current prevalence controversy may relate to current intervention, a subject for further study.
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Affiliation(s)
- Bruce Rothschild
- Northeast Ohio Medical University, Rootstown, OH.,Vertebrate Paleontology, Carnegie Museum of Natural History, Pittsburgh, PA
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Bello-Gualtero JM, Lafaurie GI, Hoyos LX, Castillo DM, De-Avila J, Munevar JC, Unriza S, Londoño J, Valle-Oñate R, Romero-Sánchez C. Periodontal Disease in Individuals With a Genetic Risk of Developing Arthritis and Early Rheumatoid Arthritis: A Cross-Sectional Study. J Periodontol 2016; 87:346-56. [DOI: 10.1902/jop.2015.150455] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ramesh Kumar SG, Aswath Narayanan MB, Jayanthi D. Comparative assessment of the prevalence of periodontal disease in subjects with and without systemic autoimmune diseases: A case-control study. Contemp Clin Dent 2016; 7:170-5. [PMID: 27307662 PMCID: PMC4906858 DOI: 10.4103/0976-237x.183069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Immune mechanism shares a common pathway both for systemic autoimmune diseases and periodontal diseases. Scientific exploration of literature revealed limited studies on the association between systemic autoimmune diseases and periodontal diseases in India. AIM The aim of the study is to find whether the presence of systemic autoimmune diseases in an individual is a risk factor for the development of periodontal disease. SETTINGS AND DESIGN This was a hospital-based case-control study. MATERIALS AND METHODS A sample of 253 patients with systemic autoimmune diseases, attending the Rheumatology Department of Government General Hospital, Chennai-3, and 262 patients without systemic autoimmune diseases, attending the outpatient department of the Tamil Nadu Government Dental College and Hospital, Chennai-3, constituted the case and control groups, respectively. Age, gender, and oral hygiene status matching was done. Oral hygiene status was assessed using oral hygiene index (OHI) and periodontal status was assessed using community periodontal index (CPI) and loss of attachment (LOA) index. STATISTICAL ANALYSIS Statistical analysis was done using SPSS version 15 (SPSS Inc, 2006, Chicago). RESULTS Results showed 99.2% and 73.9% prevalence of gingivitis and periodontitis, respectively, in the case group as compared to 85.5% and 14.9%, respectively, in the control group. There is no linear relationship between OHI scores and prevalence of periodontitis (CPI and LOA scores) in the case group. Patients suffering from systemic autoimmune diseases showed more prevalence of periodontal diseases irrespective of oral hygiene scores. CONCLUSION It is postulated that the presence of systemic autoimmune diseases may pose a risk for the development of periodontal diseases.
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Affiliation(s)
- S. G. Ramesh Kumar
- Department of Public Health Dentistry, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - M. B. Aswath Narayanan
- Department of Public Health Dentistry, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - D. Jayanthi
- Department of Public Health Dentistry, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
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Oral manifestations of rheumatoid arthritis. A cross-sectional study of 73 patients. Clin Oral Investig 2016; 20:2575-2580. [PMID: 26888220 DOI: 10.1007/s00784-016-1745-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A study is made of the main oral manifestations of patients with rheumatoid arthritis (RA), particularly salivary flow, and of its possible association to periodontal disease. MATERIAL AND METHODS A prospective comparative study was made of 146 patients (73 with RA and 73 controls), recording pocket depth, clinical attachment loss, bleeding index, plaque index, and the DMFT index to assess periodontal and dental alterations. Sialometric measurements were also made to determine resting, stimulated, and parotid salivary flow. RESULTS The patients with RA had greater periodontal pocket depths (with moderate depths in most cases), as well as greater attachment loss and more bacterial plaque. The resting whole saliva and stimulated parotid saliva rates were also clearly decreased in the RA group compared with the controls. CONCLUSIONS Patients with RA are more likely to present periodontal disease, poorer oral hygiene manifesting as an increased accumulation of bacterial plaque, and decreased salivary flow rates. CLINICAL RELEVANCE Vulnerability to periodontitis is confirmed in one of the largest samples ever studied of patients with rheumatoid arthritis (RA). Also, there is evidence of hyposialia (decrease in salivary rate) in RA patients without Sjögren's syndrome.
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Roman-Torres CVG, Neto JS, Souza MA, Schwartz-Filho HO, Brandt WC, Diniz REAS. An Evaluation of Non-Surgical Periodontal Therapy in Patients with Rheumatoid Arthritis. Open Dent J 2015; 9:150-3. [PMID: 26140059 PMCID: PMC4484346 DOI: 10.2174/1874210601509010150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/01/2015] [Accepted: 04/13/2015] [Indexed: 01/01/2023] Open
Abstract
aim of this study was to evaluate the efficacy of periodontal scaling and oral hygiene instruction for patients with mild chronic periodontitis and rheumatoid arthritis through clinical periodontal parameters and laboratory tests for CRP (C- reactive protein) and ESR (erythrocyte sedimentation rate). Twelve individuals with rheumatoid arthritis and
12 healthy individuals were evaluated, with a mean age of 45.38 and 46.75 respectively, all female and with mild, chronic periodontitis. The participants were evaluated clinically and periapical radiographs were taken (T1), after which periodontal treatment was instituted. After ninety days (T2), new clinical and laboratory data were obtained. Probing depth, bleeding index, and plaque indexes were observed in both groups, and the results demonstrated reductions but no statistical differences. Laboratory tests for CRP and ESR produced higher values for the rheumatoid arthritis group with T1- T2 reductions on the average, but the values were still higher than in the health group. We conclude that periodontal therapy in patients with rheumatoid arthritis and mild chronic periodontitis showed a improvement in the periodontal clinical parameters and laboratory tests that were evaluated.
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Affiliation(s)
- Caio V G Roman-Torres
- Department of Dentistry, University of Santo Amaro, SP, Brazil ; Department of Periodontology, Metropolitan University of Santos, SP, Brazil
| | - José S Neto
- Department of Periodontology, Metropolitan University of Santos, SP, Brazil
| | - Marcio A Souza
- Department of Periodontology, Metropolitan University of Santos, SP, Brazil
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Payne JB, Golub LM, Thiele GM, Mikuls TR. The Link Between Periodontitis and Rheumatoid Arthritis: A Periodontist's Perspective. CURRENT ORAL HEALTH REPORTS 2015; 2:20-29. [PMID: 25657894 PMCID: PMC4312393 DOI: 10.1007/s40496-014-0040-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In this review, we critically evaluate the case-control studies examining the relationship between rheumatoid arthritis (RA) and periodontitis, two common chronic inflammatory diseases with a similar host-mediated pathogenesis. We review the "two-hit" periodontitis model that our group previously proposed, in which we elucidate how a systemic disease such as RA can potentially exacerbate or initiate periodontitis. Furthermore, we discuss adjunctive host modulation therapy, originally developed for periodontitis (i.e., subantimicrobial-dose doxycycline alone or in combination with an anti-inflammatory agent), to simultaneously mitigate RA and periodontitis. Finally, we review studies describing periodontal treatment effects on both RA disease activity measures and systemic inflammation. Current evidence suggests that an association exists between periodontitis and RA. Well-designed multicenter longitudinal clinical trials and studies with sufficient sample sizes are needed to ascertain the temporal relationship between these two diseases and whether periodontal treatment can reduce the severity of RA or prevent its onset.
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Affiliation(s)
- Jeffrey B. Payne
- Department of Surgical Specialties, Division of Periodontics, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE USA
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
- Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, 40th & Holdrege, Lincoln, NE 68583 USA
| | - Lorne M. Golub
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, New York 11794-8700 USA
| | - Geoffrey M. Thiele
- Omaha Veterans Affairs Medical Center (VAMC) and Nebraska Arthritis Outcomes Research Center, Division of Rheumatology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, 983025 Nebraska Medical Center, Omaha, NE 68198-3025 USA
| | - Ted R. Mikuls
- Omaha Veterans Affairs Medical Center (VAMC) and Nebraska Arthritis Outcomes Research Center, Division of Rheumatology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, 983025 Nebraska Medical Center, Omaha, NE 68198-3025 USA
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Bostanci V, Toker H, Senel S, Ozdemir H, Aydin H. Effect of Chronic Periodontitis on Serum and Gingival Crevicular Fluid Oxidant and Antioxidant Status in Patients With Familial Mediterranean Fever Before and After Periodontal Treatment. J Periodontol 2014; 85:706-12. [DOI: 10.1902/jop.2013.130230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Monsarrat P, Vergnes JN, Cantagrel A, Algans N, Cousty S, Kémoun P, Bertrand C, Arrivé E, Bou C, Sédarat C, Schaeverbeke T, Nabet C, Sixou M. Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis: study protocol of the randomized, controlled ESPERA trial. Trials 2013; 14:253. [PMID: 23945051 PMCID: PMC3751435 DOI: 10.1186/1745-6215-14-253] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 07/30/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic inflammatory disorder that leads to joint damage, deformity, and pain. It affects approximately 1% of adults in developed countries. Periodontitis is a chronic oral infection, caused by inflammatory reactions to gram-negative anaerobic bacteria, and affecting about 35 to 50% of adults. If left untreated, periodontitis can lead to tooth loss. A significant association has been shown to exist between periodontitis and RA in observational studies. Some intervention studies have suggested that periodontal treatment can reduce serum inflammatory biomarkers such as C-reactive protein, or erythrocyte sedimentation rate. We hypothesize that periodontitis could be an aggravating factor in patients with RA, and that its treatment would improve RA outcomes. The aim of this clinical trial is to assess the effect of periodontal treatment on the biological and clinical parameters of patients with RA. METHODS/DESIGN The ESPERA (Experimental Study of Periodontitis and Rheumatoid Arthritis) study is an open-label, randomized, controlled trial. Subjects with both RA and periodontitis will be recruited at two university hospitals in southwestern France. In total, 40 subjects will be randomized into two arms (intervention and control groups), and will be followed up for 3 months. Intervention will consist of full-mouth supra-gingival and sub-gingival non-surgical scaling and root planing, followed by systemic antibiotic therapy, local antiseptics, and oral hygiene instructions. After the 3-month follow-up period, the same intervention will be applied to the subjects randomized to the control group.The primary outcome will be change of in Disease Activity Score in 28 Joints (DAS28) at the end of the follow-up period. Secondary outcomes will be the percentages of subjects with 20%, 50%, and 70% improvement in disease according to the American College of Rheumatology criteria. Health-related quality of life assessments (the Health Assessment Questionnaire and the Geriatric Oral Health Assessment Index) will also be compared between the two groups. DISCUSSION Evidence-based management of potential aggravating factors in subjects with active RA could be of clinical importance, yet there are few randomized controlled trials on the effect of periodontal treatment on the clinical parameters of RA. The ESPERA trial is designed to determine if non-surgical periodontal treatment could improve clinical outcomes in patients with active RA, and the quality of life of these patients. TRIAL REGISTRATION The ESPERA Trial was registered in Current Controlled Trials [ISRCTN79186420] on 2012/03/20. The trial started recruiting on 2012/03/06.
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Affiliation(s)
- Paul Monsarrat
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
| | - Jean-Noël Vergnes
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
| | - Alain Cantagrel
- Department of Rheumatology, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Nadège Algans
- Clinical Research and Innovation Department (DRCI), Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Sarah Cousty
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
| | - Philippe Kémoun
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
| | - Caroline Bertrand
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France
- Department of Odontology, Bordeaux 2 University, Bordeaux, France
| | - Elise Arrivé
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France
- Department of Odontology, Bordeaux 2 University, Bordeaux, France
| | - Christophe Bou
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France
- Department of Odontology, Bordeaux 2 University, Bordeaux, France
| | - Cyril Sédarat
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France
- Department of Odontology, Bordeaux 2 University, Bordeaux, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, Bordeaux University Hospital, Bordeaux 2 University, Bordeaux, France
| | - Cathy Nabet
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
| | - Michel Sixou
- Department of Dentistry, Toulouse University Hospital (CHU de Toulouse) and Toulouse Dental School, Paul Sabatier University, Toulouse, France
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Kaur S, White S, Bartold PM. Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res 2013; 92:399-408. [PMID: 23525531 DOI: 10.1177/0022034513483142] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This systematic review considers the evidence available for a relationship between periodontal disease and rheumatoid arthritis. MEDLINE/PubMed, CINAHL, DOSS, Embase, Scopus, Web of Knowledge, MedNar, and ProQuest Theses and Dissertations were searched from the inception of the database until June 2012 for any quantitative studies that examined the association between periodontal disease and rheumatoid arthritis. Nineteen studies met our inclusion criteria. Good evidence was found to support an association between these conditions with regard to tooth loss, clinical attachment levels, and erythrocyte sedimentation rates. Moderate evidence was noted for C-reactive protein and interleukin-1β. Some evidence for a positive outcome of periodontal treatment on the clinical features of rheumatoid arthritis was noted. These results provide moderate evidence based on biochemical markers and stronger evidence with regard to clinical parameters that common risk factors or common pathologic processes may be responsible for an association between rheumatoid arthritis and periodontal disease. Further studies are required to fully explore both the biochemical processes and clinical relationships between these 2 chronic inflammatory conditions. There is a need to move from case-control studies to more rigorous studies using well-defined populations and well-defined biochemical and clinical outcomes as the primary outcome measures with consideration of potential confounding factors.
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Affiliation(s)
- S Kaur
- Colgate Australian Clinical Dental Research Centre (CACDRC), Adelaide Dental Hospital, University of Adelaide, SA 5005, Australia, associated with the Joanna Briggs Institute, Faculty of Health Sciences, the University of Adelaide, SA 5005
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Susanto H, Nesse W, Kertia N, Soeroso J, Huijser van Reenen Y, Hoedemaker E, Agustina D, Vissink A, Abbas F, Dijkstra PU. Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. J Periodontol 2012; 84:1067-74. [PMID: 23075431 DOI: 10.1902/jop.2012.110321] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA. METHODS A full-mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age-, sex-, and smoking-matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high-sensitivity C-reactive protein (hsCRP), rheumatoid factor, and anti-citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses. RESULTS No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti-inflammatory drugs, whereas none of the controls used such drugs. CONCLUSION Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.
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Affiliation(s)
- Hendri Susanto
- Department of Oral Medicine, Faculty of Dentistry, Gadjah Mada University, Yogyakarta, Indonesia
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Torkzaban P, Hjiabadi T, Basiri Z, Poorolajal J. Effect of rheumatoid arthritis on periodontitis: a historical cohort study. J Periodontal Implant Sci 2012; 42:67-72. [PMID: 22803007 PMCID: PMC3394997 DOI: 10.5051/jpis.2012.42.3.67] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/16/2012] [Indexed: 11/08/2022] Open
Abstract
Purpose Rheumatoid arthritis (RA) is a chronic multi-systemic disease that causes damage to the bone and connective tissues. This study was conducted in order to accurately measure the correlation between RA and periodontitis, and to obtain an unbiased estimate of the effect of RA on periodontal indices. Methods In this historical cohort study, which was conducted from February to May 2011 in Hamadan city, Iran, 53 exposed people (with RA) were compared with 53 unexposed people (without RA) in terms of clinical periodontal indices (the outcomes of interest) including 1) plaque index (PI), 2) bleeding on probing (BOP), and 3) clinical attachment loss (CAL). Results A sample of 106 volunteers were evaluated, 53 rheumatoid versus 53 non-rheumatoid subjects. There was a statistically significant correlation between RA and BOP (P<0.001) and between RA and CAL (P<0.001). However, there was no statistically significant correlation between RA and any of the periodontal indices. No correlation was seen between gender and any of the indices either. There was a strong positive correlation between age and all three periodontal indices (P<0.001). Conclusions The present study indicated a potential effect of RA on periodontal indices. However, much more evidence based on a prospective cohort study is needed to support the cause and effect relationship between RA and periodontal indices.
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Affiliation(s)
- Parviz Torkzaban
- Department of Periodontology, Hamadan University of Medical Sciences School of Dentistry, Hamadan, Iran
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Temporomandibular Joint Problems and Periodontal Condition in Rheumatoid Arthritis Patients in Relation to Their Rheumatologic Status. J Oral Maxillofac Surg 2011; 69:2971-8. [DOI: 10.1016/j.joms.2011.02.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/21/2011] [Indexed: 01/07/2023]
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Abdelsalam SK, Hashim NT, Elsalamabi EM, Gismalla BG. Periodontal status of rheumatoid arthritis patients in khartoum state. BMC Res Notes 2011; 4:460. [PMID: 22035090 PMCID: PMC3223151 DOI: 10.1186/1756-0500-4-460] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the periodontal condition among Rheumatoid arthritis in Sudan. The present study described the periodontal condition among Sudanese patients suffering from rheumatoid arthritis and to compare them with those of non-rheumatic subjects. METHODS A group of eighty rheumatoid arthritis patients was selected from Patient's Rheumatoid Clinics in Khartoum State during the period of January to May 2010. A control group of eighty patients with the same age and gender was selected for the study. Both Rheumatoid arthritis patients and the control group were examined for their plaque index, gingival index, and clinical attachment loss. RESULTS The results revealed that there were no significant differences in plaque and gingival index among study and control groups, with mean plaque index of (1.25 ± 0.4) for patients and (1.17 ± 0.28) for the control group (p-value is 0.3597). The mean gingival index was (1.2 ± 0.24) for the patients and (1.2 ± 0.33) for the control (p = is 0.3049). The results showed statistically significant differences in clinical attachment loss between study and control groups, with mean clinical attachment loss of (1.03 ± 0.95) for the study group and (0.56 ± 0.63) for the control group (p = 0.0002). The study revealed that no association exists between the type of drug used to treat rheumatoid arthritis (NSAIDs & DMARDs) and the periodontal parameters (plaque index, gingival index, and clinical attachment loss). CONCLUSION A significant relationship between periodontal disease and Rheumatoid Arthritis does exist, but no difference between plaque and gingival index has been detected among study and control groups.
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Affiliation(s)
- Safa K Abdelsalam
- Department of periodontology, School of Dentistry, Elneilein University, Khartoum, Sudan
| | - Nada T Hashim
- Department of Periodontology, Khartoum North Dental Teaching Hospital, Khatroum, Sudan
| | - Emitithal M Elsalamabi
- Department of rheumatology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Bakri G Gismalla
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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Queiroz-Junior CM, Madeira MFM, Coelho FM, Costa VV, Bessoni RLC, Sousa LFDC, Garlet GP, Souza DDGD, Teixeira MM, Silva TAD. Experimental arthritis triggers periodontal disease in mice: involvement of TNF-α and the oral Microbiota. THE JOURNAL OF IMMUNOLOGY 2011; 187:3821-30. [PMID: 21890656 DOI: 10.4049/jimmunol.1101195] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Rheumatoid arthritis (RA) and periodontal disease (PD) are prevalent chronic inflammatory disorders that affect bone structures. Individuals with RA are more likely to experience PD, but how disease in joints could induce PD remains unknown. This study aimed to experimentally mimic clinical parameters of RA-induced PD and to provide mechanistic findings to explain this association. Chronic Ag-induced arthritis (AIA) was triggered by injection of methylated BSA in the knee joint of immunized mice. Anti-TNF-α was used to assess the role of this cytokine. Intra-articular challenge induced infiltration of cells, synovial hyperplasia, bone resorption, proteoglycan loss, and increased expression of cytokines exclusively in challenged joints. Simultaneously, AIA resulted in severe alveolar bone loss, migration of osteoclasts, and release of proinflammatory cytokines in maxillae. Anti-TNF-α therapy prevented the development of both AIA and PD. AIA did not modify bacterial counts in the oral cavity. PD, but not AIA, induced by injection of Ag in immunized mice was decreased by local treatment with antiseptic, which decreased the oral microbiota. AIA was associated with an increase in serum C-reactive protein levels and the expression of the transcription factors RORγ and Foxp3 in cervical lymph nodes. There were higher titers of anti-collagen I IgG, and splenocytes were more responsive to collagen I in AIA mice. In conclusion, AIA-induced PD was dependent on TNF-α and the oral microbiota. Moreover, PD was associated with changes in expression of lymphocyte transcription factors, presence of anti-collagen Abs, and increased reactivity to autoantigens.
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Affiliation(s)
- Celso Martins Queiroz-Junior
- Departamento de Clínica, Patologia e Cirurgia Odontológicas, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Jayatilake JAMS, Rajapakse S, Weerasinghe IE, Wanigasekara P, Vasanthathilaka J. Oral hygiene and periodontal status in a group of patients with rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60072-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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de Pablo P, Chapple ILC, Buckley CD, Dietrich T. Periodontitis in systemic rheumatic diseases. Nat Rev Rheumatol 2009; 5:218-24. [PMID: 19337286 DOI: 10.1038/nrrheum.2009.28] [Citation(s) in RCA: 307] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors might contribute to a noncausal association between both conditions.
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Affiliation(s)
- Paola de Pablo
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston Birmingham, UK.
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