Background/Purpose: Transversal cohort studies demonstrated a possible association between periodontal disease (PD) and rheumatoid arthritis (RA). However it is unknown how this association evolves during the disease course. In this study we aimed to compare the severity of PD in RA patients versus non-RA healthy controls prior to clinical diagnosis of RA and thereafter. Additionally, the correlation was analyzed between RA disease activity and PD severity and progression in the same period.

Methods: Data (retrospective with a follow-up of 10 years) of 98 RA patients from general practices and matched healthy control patients from the University Dental College were analyzed. Medical files and dental treatment records were evaluated. PD was analyzed via radiographic assessment using the new periodontal classification system from 2017. Primary outcome measures were the severity and extent of periodontitis (Stage and Grade) and the RA disease activity (DAS28, cumulative DAS28-score). Secondary analytes were gender, year of birth and age at diagnosis, smoking habits, frequency of dental visits for check-up, frequency and duration of periodontal debridement and the presence of rheumatoid factor (RF) and anti-cyclic citrullinated protein antibodies (Anti-CCP). Statistical analyses were performed with IBM SPSS Statistic 25. Depending on the variables Chi-Square Test, Mann-Whitney U Test, Wilcoxon Signed Rank Test, Spearman Correlation and ANOVA were used.

Results: More RA patients had severe periodontitis (stage III/IV) compared to matched healthy controls. The fraction of RA patients with severe PD increased 23% before diagnosis to 43% 5-10 years after diagnosis. The largest part of these patients developed a severe PD with a moderate risk/rate of progression. The proportion of patients that regularly visited the dentist increased from 70% before diagnosis to 80% for patients with mild PD and 94% of patients with severe PD 5-10 years after diagnosis. Development of PD did not differ between sexes or between seronegative and seropositive RA. Patients with severe PD and patients with a high risk of PD progression before RA diagnosis had a higher cumulative DAS28-score than patients with mild PD in the first 7 years after RA treatment initiation.

Conclusion: PD occurs in a proportion of RA patients before diagnosis and in an increasing proportion of patients in the years after diagnosis. PD is associated with decreased response to anti-rheumatic treatment in the years after diagnosis. A proportion of RA patients with radiographic PD infrequently undergoes dental follow up for PD treatment, especially in the years before RA diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/periodontal-status-before-diagnosis-in-patients-with-rheumatoid-arthritis-predicts-cumulative-disease-activity-in-years-after-treatment-inititation/