Background/Purpose Periodontal disease (PD) or periodontitis is currently considered an epigenetic determinant of both occurrence  and severity of Rheumatoid Arthritis (RA). Common pathophysiological mechanisms like the migration of osteoclasts and secretion of pro-inflammatory cytokines, would occur in RA and PD but it has not been determined if the severity of PD influence on joint damage (JD). The aim of the study was to demonstrate that a more severe PD is independently associated with a greater JD in RA patients.

Methods Method: A cross sectional study. RA was defined using the 1987 ACR criteria. Patients should not have other autoimmune disease and they were older than 18 years at time of diagnosis. We excluded patients with less than 4 teeth, serious or local ongoing infections, oral cancer or precancerous lesions; inpatients, pregnant, diabetic patients, severe Sjögren syndrome and local antibiotic or gingival hyperplasia associated drug users were also excluded. We applied a personal interview, physical examination, laboratory analysis and review of medical records to assess factors associated with JD. An assessment of  periodontal attachment  loss  and panoramic dental X ray were done. To determine diagnosis and severity of PD the American Academy of Periodontology criteria were applied.  Two categories were defined mild PD and moderate/severe PD. All dental assessments and radiographs were interpreted by three odolontologist blinded to JD. A blinded investigator to clinical RA and PD status determined JD scoring hands/feet radiographs according to Sharp VDH method. The association of PD severity and JD was determined using student’s T test, after that a multivariable linear regression model adjusted for age, tobacco, gender, rheumatoid factor (RF), anticitrullinate protein antibody (ACPA), disease duration, socioeconomic status (SES) using Graffar scale, disease activity (DAS28CRP), functional status (MDHAQ) and quality of life (SF36) was performed to determined persistence of the associations. SPSSv21.0 statistical package was used.

Results 213 patients were evaluated, 192 (90.1%) were women, mean (SD) age was 59.55 (12.59) years, disease duration was 15.14 (11.74) years, SES were more frequently medium / medium low (31.5% and 36.6% respectively); 79.3% were ACPA positive, mean ACPA title was 679.23 uM/L , mean DAS28PCR was  3.85 (1.24). 2.3% and 14.6% were current or past smokers. Erosion, joint space narrowing and total Sharp VDH scores were 41.25 (49.02), 64.65 (42.30) and 105.81 (88.44) respectively; 94 (44.1%) patients had mild PD and 119 (55.9%) patients had moderate/ severe PD. In multivariable analysis PD severity  (adjusted for age, SES, tobacco, gender, RF,ACPA, disease duration, DAS28PCR, MDHAQ and SF36 ) was independently associated with a higher score join narrowing space (Β:21.47, p =0.008 ) and total SharpVDH scores (Β:17.78 , p=0.029 ). Erosions and PD severity did not remain associated (Β:18.17, p=0.085).

Conclusion A more severe PD impacts on structural joint damage independently of other known associated factors. A routine periodontal evaluation and monitoring could be useful for better outcomes in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/periodontal-disease-and-its-impact-on-structural-joint-damage-in-a-rheumatoid-arthritis-peruvian-population/