Background/Purpose: Oral health is an important issue for the patients with rheumatoid arthritis (RA) because many RA patients were treated with bisphosphonates and bisphosphate use appears to be associated with osteonecrosis at Jaw (ONJ), and periodontitis is a potential risk factor for RA. Limited data exist in the literature concerning the dental treatment, tooth extraction, and ONJ in Japanese patients with RA. This study aimed to evaluate the dental treatments, tooth extraction, and ONJ in our Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort.

Methods: The IORRA cohort was established in 2000 as a single institute-based large cohort of Japanese RA patients conducted at the Institute of Rheumatology, Tokyo Women’s Medical University (Tokyo, Japan). More than 100 publications have described various characteristics of Japanese RA patients using this cohort. Patients with RA enrolled in IORRA cohort completed self-administered questionnaires as part of the April IORRA surveys of 2014, which included their dental treatment, tooth extraction at dentists during the past 6 months from October 2013 to March 2014, and past history of ONJ. The past histories of ONJ were validated with the patients’ medical records. Logistic regression was used to determine the association variables and tooth extraction.

Results: Among 5,779 Japanese patients with RA (median age 65 years old, female 85%), 2,323 patients (40.2%) and 378 (6.5%) reported to have dental treatment and extracted tooth at dentist during the past 6 months, respectively. Among 1,257 patients with RA treated with oral bisphosphonate and denosmab, 533 patients (42.4%) and 83 (6.6%) reported to have dental treatment and extracted tooth during the 6 months, respectively. Among the patients who had tooth extraction and took bisphosphonate during the 6 months (n = 34), 22 (64.7%) were advised to stop bisphosphonates before the tooth extraction by physicians and dentists. In multivariate model, advanced age (P = 0.0060) and current smoking (P = 0.0072) were associated with tooth extraction. Among the patients, 25 patients reported to have a history of ONJ. Among them, we confirmed ONJ with their medical records in 6 patients during the past 36 months (Table). Among the 6 patients with ONJ, they were all female aged over 65 years old, 5 and 4 were treated with oral bisphosphonates and prednisolone, respectively, at the diagnosis of ONJ, 1 had a history of oral bisphosphonate treatment, and 2 were complicated with diabetes. The incidence rate of ONJ was 0.35/1,000 person-years in all RA patents, 0.93/1,000 person-years in female RA patients over 65 years.

Table. Clinical characteristics of 6 Japanese RA patients with ONJ

Conclusion: In Japanese patients with RA, many patients have dental treatment and tooth extraction at dentists. Japanese physicians should consult dentists before and after prescribing bisphosphonates and denosmab especially for elderly female RA patients taking prednisolone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dental-treatments-tooth-extraction-and-osteonecrosis-at-jaw-in-japanese-patients-with-rheumatoid-arthritis-results-from-the-iorra-cohort-study/