A population survey of rheumatoid arthritis. Epidemiological aspects of the syndrome, its pattern, and effect on gainful employment

Relationship between rheumatoid arthritis and periodontitis

BACKGROUND

Because of several similar features in the pathobiology of periodontitis and rheumatoid arthritis, in a previous study we proposed a possible relationship between the two diseases. Therefore, the aims of this study were to study a population of rheumatoid arthritis patients and determine the extent of their periodontal disease and correlate this with various indicators of rheumatoid arthritis.

METHODS

Sixty-five consecutive patients attending a rheumatology clinic were examined for their levels of periodontitis and rheumatoid arthritis. A control group consisted of age- and gender-matched individuals without rheumatoid arthritis. Specific measures for periodontitis included probing depths, attachment loss, bleeding scores, plaque scores, and radiographic bone loss scores. Measures of rheumatoid arthritis included tender joint analysis, swollen joint analysis, pain index, physician's global assessment on a visual analogue scale, health assessment questionnaire, levels of C-reactive protein, and erythrocyte sedimentation rate. The relationship between periodontal bone loss and rheumatological findings as well as the relationship between bone loss in the rheumatoid arthritis and control groups were analyzed.

RESULTS

No differences were noted for the plaque and bleeding indices between the control and rheumatoid arthritis groups. The rheumatoid arthritis group did, however, have more missing teeth than the control group and a higher percentage of these subjects had deeper pocketing. When the percentage of bone loss was compared with various indicators of rheumatoid arthritis disease activity, it was found that swollen joints, health assessment questionnaire scores, levels of C-reactive protein, and erythrocyte sedimentation rate were the principal parameters which could be associated with periodontal bone loss.

CONCLUSIONS

The results of this study provide further evidence of a significant association between periodontitis and rheumatoid arthritis. This association may be a reflection of a common underlying disregulation of the inflammatory response in these individuals.

Epidemiology of rheumatoid arthritis in Finland

OBJECTIVES

To review the work pertaining to rheumatoid arthritis (RA) morbidity in Finland and to compare the data with that available from other countries.

METHODS

Extensive investigations in Finland of the epidemiology of RA, based on nationwide registers designed primarily for administrative purposes and on extensive population studies, frequently in combination.

RESULTS

According to several surveys with somewhat different study designs, the prevalence of clinically significant RA is about 0.8% of the adult Finnish population. Five national health interviews from a 30-year period have revealed figures about 50% higher, but with no clear change in prevalence. The incidence of clinically significant RA is about 40 per 100,000 of the adult population, which is in accordance with the prevalence figures. The mean age at diagnosis increased by 7.6 years from 1975 to 1990. Between 1978 and 1980, 5.8% of the severe disability in the adult Finnish population was attributable to RA. Some evidence suggests that severe disability resulting from RA diminished during the 1980s, possibly because of joint replacement surgery.

CONCLUSIONS

Monitoring sickness insurance statistics is a useful means of following the epidemiology of RA.

The economic impact of musculoskeletal disorders

Musculoskeletal disorders have a major impact on society in terms of morbidity, long-term disability and economics. As populations increase and age, payment for medical care and indirect costs from loss of earnings will increase. Both rheumatoid arthritis and low back pain have a great economic impact on society, and the costs of these are escalating problems. Statistics are analysed from various studies in the United States and Canada, and these highlight the need for more rational and effective health care management strategies.

Radiologic changes in temporomandibular, hand, and foot joints of patients with rheumatoid arthritis

Radiologic changes in the temporomandibular joint (TMJ) and in the joints of the hand and foot were recorded for 90 adult patients with rheumatoid arthritis. The severity of the changes was graded according to the Larsen classification of six grades (O to V), and mainly erosive changes were recorded. The assessment of the radiographs was performed with the aid of reference films. The radiologic changes in the TMJs corresponded to grade II (definite early abnormality) and paralleled those of most of the metacarpophalangeal and metatarsophalangeal joints. The most severe changes were localized to the wrists, with a median grade of III (moderate destructive abnormality). The severity of the changes was similar on the right and left sides of the TMJ. We conclude that TMJ involvement in patients with rheumatoid arthritis is severe and warrants a thorough initial clinical examination. Such a strategy will facilitate the diagnosis and treatment of TMJ changes in the early stages of the disease.

General oral status in adults with rheumatoid arthritis

The oral status of an adult population of 204 patients with rheumatoid arthritis (RA) was compared with that of an age and sex-matched random sample of non-rheumatic subjects. The percentage of edentulous subjects, number of existing teeth in dentate subjects, prevalence, and quality of fixed and removable prostheses and prevalence of disorders of the stomatognathic system was recorded. The percentage of edentulousness among RA-patients was 17% and among non-RA subjects 19%. Number of remaining teeth was equal. 75% of removable partial and 62% of complete dentures among RA-patients were considered unsatisfactory compared to 25% and 56% respectively among non-RA subjects. Disorders related to the TMJ occurred much more frequently among RA-patients than among non-RA subjects. It is suggested that thorough stomatognathic examination and TMJ-prophylaxis be included in the overall care of RA-patients.

Periodontal conditions in adults with rheumatoid arthritis

Periodontal conditions among an adult population of 161 dentate patients with rheumatoid arthritis (RA) were compared with those of an age and sex-matched random sample of non-rheumatic subjects. The number of teeth and prevalence of dental plaque, calculus, gingivitis, and deepened periodontal pockets were recorded. Alveolar bone breakdown and the distribution of subjects according to severity of periodontal disease were also registered. There was a tendency towards better periodontal conditions among RA-patients, severe periodontal breakdown occurring less frequently among RA-patients (12%) than among the controls (16%). The RA-patients had less plaque and calculus than the control group, a finding which could indicate a difference in periodontal care.

Physical disease and disability among 416 suicide cases in Sweden

All suicides occurring among the inhabitants of the County of Uppsala in Sweden between 1977 and 1984 were analyzed on the basis of information from autopsy reports and from somatic and psychiatric medical records. Among the 416 persons who committed suicide, 70 (17%) had a somatic disease of probable importance for the suicidal act. No somatic diagnosis appeared to stand out as being especially associated with a very high risk of suicide. Some diagnoses (e.g. malignant neoplasm, Parkinson's disease, multiple sclerosis) were, however, associated with a suicidal rate above that in the general population. Further knowledge about the relation between suicide and specific somatic diagnoses would be of value, since a high suicide rate in association with a particular illness might indicate insufficient medical care and rehabilitation.

Rheumatoid arthritis in a medical information system: how valid is the diagnosis?

In order to validate the Stockholm County Medical Information System with regard to rheumatoid arthritis (RA) we have studied the medical records of 276 cases coded as RA in the medical information system. We searched information on the criteria for RA from (1961) and New York (1966). 18% of the medical records lacked information to the extent that an assessment of the number of criteria fulfilled was not possible. 9% fulfilled only one New York criterion and 7% fewer than three Rome criteria. 47% fulfilled four New York criteria and 35% at least seven Rome criteria. The most complete information on criteria was found in medical records from departments of rheumatology and these had also the highest degree of criteria fulfillment. A comparison is also presented between this sample of cases and a sample of RA persons selected from the general population with regard to fulfillment of criteria.

The assessment of radiological changes in the hands and wrists in rheumatoid arthritis

Two methods of assessing changes in hand and wrist radiographs, the Larsen Index and Amos Index, were compared and contrasted in 48 patients with rheumatoid arthritis (RA). X-rays were taken before and after 1 year of treatment with remission-inducing drugs and scored independently by three observers using both methods. Single readings of radiographs using the Larsen Index were highly reproducible (intra- and inter-observer correlations greater than 0.90 on all occasions), but reproducibility fell when changes were determined from paired films (intra- and inter-observer correlations 0.47-0.82). Variability was greatest in the proximal interphalangeal and wrist joints. The Amos Index, which assesses erosive progression and not the appearance of single films, was more reproducible (intra- and inter-observer correlations 0.72-0.94); it would therefore be better able to detect small changes in groups of patients. The scoring systems were significantly correlated (r = 0.63; P less than 0.001), and with both different observers scored the films at the same "level'. The Amos Index is simple, reproducible, and does not require standard films. It is the assessment of choice.

Reproducibility of response to a questionnaire on symptoms of masticatory dysfunction

The aim of the present investigation was to check the reproducibility of answers to multiple-choice questions used in a questionnaire. The questionnaire was concerned with symptoms in patients with dysfunction of the masticatory system. Five main types of questions were tested by repetition within 1 week by 98 patients. Comparisons were also made between questionnaire data and clinical findings. The interval between the questionnaire and the clinical examination was 1 week. The best reproducibility was found for answers to a question about previous joint radiography, which was the simplest question with the fewest alternatives. The second best was found for a question about the duration of the symptoms referable to the masticatory system. The poorest reproducibility was noted for a question about masticatory muscle pain. The comparison between the questionnaire data and clinical findings showed the best agreement for joint sounds. The reported pain symptoms and palpatory tenderness seem to be different entities.