Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Periodontitis (PD) is associated with many chronic health conditions including rheumatoid arthritis (RA). Affecting one-third to one-half of the US population, the high prevalence of PD underscores its potential impact. PD may play a role in initiating or worsening RA. Yet, studies are often hindered by resource intensive full-mouth exams required for PD diagnosis whereas new self-report methods can reduce cost. Many studies indicate that PD has a different presentation in RA patients. It is unknown whether this difference affects performance of self-report measures. The purpose of this study was to evaluate self-report against the reference standard of clinically-defined PD in RA and osteoarthritis (OA) patients after accounting for factors associated with PD.
Methods: Six self-report PD questions were evaluated in RA and OA patients. All RA patients met ACR criteria and OA patients were classified based on physician diagnosis or corresponding x-ray results. Self-report questions were validated against a reference standard of severe or moderate-to-severe PD based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported ‘bone loss/deep pockets’ and ‘loose teeth’ was assessed; associations of self-report with RA disease characteristics were explored.
Results: Self-report performed similarly in RA and OA, with individual specificity for PD ≥ 68% and sensitivity between 10% and 45%. Question-only models yielded c-statistics of 0.66-0.72 while risk factor-only models yielded c-statistics of 0.74-0.79. The best performing models incorporated both self-report questions and PD risk factors with c-statistics ≥0.79. Greater radiographic alveolar bone loss was observed among participants reporting ‘bone loss or deep pockets’ (p<0.001) and ‘loose teeth' (p<0.001). Among RA patients, ‘loose teeth', but not other self-report items, was associated with rheumatoid factor positivity (p=0.047) and higher disease activity (p<0.001).
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Table 1 Logistic Regression for Final Models after Backward Stepwise Selection |
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Variables |
Overall (n=592) |
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RA (n=275) |
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OA (n=317) |
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Severe PD |
Mod-Sev PD |
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Severe PD |
Mod-Sev PD |
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Severe PD |
Mod-Sev PD |
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Odds Ratio (95% Confidence Interval) |
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Demographics |
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|
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|
|
|
|
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Age, yrs |
1.05 (1.03-1.08) |
1.05 (1.03-1.08) |
|
1.05 (1.02-1.08) |
1.05 (1.01-1.08) |
|
1.04 (1.03-4.94) |
1.05 (1.02-1.09) |
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Male (Female Ref.) |
2.43 (1.48-3.97) |
2.77 (1.66-4.63) |
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2.71 (1.25-5.45) |
2.51 (1.17-5.35) |
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2.75 (1.34-5.64) |
3.12 (1.56-6.26) |
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Education |
0.84 (0.76-0.94) |
0.82 (0.72-0.94) |
|
— |
0.79 (0.65-0.95) |
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0.82 (0.70-0.95) |
— |
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Smoke Status |
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|
|
|
|
|
|
|
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Never |
Ref. |
Ref. |
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Ref. |
— |
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Ref. |
Ref. |
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Former |
1.99 (1.24-3.20) |
1.46 (0.84-2.52) |
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1.69 (0.86-3.33) |
— |
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2.52 (1.29-4.94) |
2.43 (1.08-5.44) |
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Current |
7.10 (3.79-13.3) |
2.64 (1.10-6.36) |
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6.43 (2.81-14.7) |
— |
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7.56 (2.78-20.5) |
5.52 (1.18-25.7) |
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Questions |
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|
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|
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Gums Bleed |
2.85 (1.72-4.72) |
2.32 (1.16-4.62) |
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3.58 (1.74-7.35) |
— |
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2.77 (1.34-5.75) |
3.13 (1.16-8.46) |
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Bone Loss/Deep Pockets |
— |
4.20 (1.72-10.2) |
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— |
— |
|
— |
6.30 (1.41-28.1) |
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Periodontal Treatment |
2.74 (1.73-4.32) |
— |
|
— |
3.39 (1.12-10.3) |
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4.17 (2.14-8.13) |
— |
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See Periodontist |
— |
— |
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— |
— |
|
— |
— |
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Loose Teeth |
2.98 (1.53-5.79) |
— |
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4.44 (1.58-12.5) |
— |
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3.01 (1.19-7.64) |
— |
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Surgery |
— |
— |
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— |
— |
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— |
— |
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Final Model AUC |
0.82 |
0.81 |
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0.79 |
0.80 |
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0.83 |
0.81 |
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All odds ratios displayed have a p-value less than 0.05. Separate models are presented for each group: rheumatoid arthritis (RA), osteoarthritis (OA) and overall. Each group is analyzed by the severe and moderate-to-severe periodontitis (PD) definitions. Area under the curve (AUC). AUCs for question-only models: Overall & Severe PD – 0.70; Overall & Mod-Sev PD – 0.67; RA & Severe PD – 0.70; RA and Mod-Sev PD – 0.66; OA & Severe PD – 0.72; OA and Mod-Sev PD – 0.68. AUCs for risk factor-only models: Overall & Severe PD – 0.76; Overall & Mod-Sev PD – 0.76; RA & Severe PD – 0.74; RA and Mod-Sev PD – 0.72; OA & Severe PD – 0.76; OA and Mod-Sev PD – 0.77. |
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Conclusion: Patient self-report, when combined with other risk factors, performs well in identifying PD among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.
Disclosure:
B. Coburn,
None;
H. Sayles,
None;
J. Payne,
None;
R. Redman,
None;
J. Markt,
None;
M. Beatty,
None;
G. Griffiths,
None;
D. McGowan,
None;
T. R. Mikuls,
None.
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