Background/Purpose: Recent clinical data show a clear association between periodontitis (P) and RA. However, there is controversy over whether severity of P is associated with RA activity. Some studies have shown no association or even a negative association and only a study (Mikuls 2014) found a positive association between severity of P and RA activity.  1.To determine whether severity of P affects clinical expression and activity of RA. 2. To define characteristics of P in RA patients with high clinical activity.

Methods: Observational, cross-sectional, case-control study adult RA patients (ACR/EULAR 2010) in a hospital Rheumatology Department,with at least 4 teeth, no dental prophylaxis or antibiotic intake 6 months before. Socio-demographic/ anthropometric variables:smoking status, Graffar scale, annual dental prophylaxis and stress level. RA variables: DAS28 (ESR) DAS28 (CRP),SDAI, RF/ACPA titles, extra-articular manifestations and comorbidities such as osteoporosis (OP), diabetes mellitus (DM), dyslipidemia (DS); glucocorticoids (GC),synthetic and biological therapy (DMARDs/DMARDb). Periodontal variables: plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), recession (REC), clinical attachment level (CAL). Dental team: 2 periodontists, 2 general dentists. Full mouth CAL PPD and periapical x-rays were taken. CAL was classified according to the European Workshop 2005 (Tonetti), into level 0 (absence), TL1 (mild), TL2 (severe).Statistical analysis (Stata 13.1) using Student´s t test , Kruskal Wallis and Chi-square test.

Results: We included 187 RA patients, F/M 78.6/21.4%,mean age 54.4 (SD 10.8) y, mean follow-up of 8.8 y, 18.72% had early RA. Positive RF/ACPA:74.9/67.8%. Mean clinical activity: DAS 28 (ESR) 3.81/ DAS 28 (CRP) 3.18/ SDAI 14.49, HAQ 0.76 (0.62). Disease activity: remission 20.86%, low activity 24.06%, moderate activity 45.45%, high activity 9.63%. Treatment: 47.06% received GC (mean daily prednisone 2.85 mg/dl); DMARDs monotherapy/combined 53%/11.76%, DMARDb 30%. Smoking status: current 19,25%/ former 24.6%; low socioeconomic status 36.36% (relative poverty 33.69%); annual dental prophylaxis 43%; dyslipidemia 53.47%, OP 55.86%. Regarding periodontal status,TL2 P in 69. 05% of patients with moderate/high activity vs 30.95% in patients with remission/low activity; 55.34% patients with TL1 P showed RA remission /low activity (p<0.001). A strong association was found between severe P and moderate/high RA activity, with an OR 57.65 + 37.40 (CI 95% 16.16- 205.62). Patients with moderate/high RA activity presented increased values of all periodontal parameters compared to low activity (p<0.005). We observed association between rheumatoid nodes, pleuritis and OP with severe P (p =0.028).  

Conclusion: 1.High-activity RA is associated with severe P. 2. Patients with moderate/high activity RA have higher prevalence of both number and percentage of probing pocket depth ≥ 5mm. 3. Presence of rheumatoid nodes and osteoporosis are related to severe P. 4.These results suggest an independent relationship between severe P and RA with high clinical disease activity regardless of classical factors associated with P.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-rheumatoid-arthritis-disease-activity-and-clinical-profile-with-chronic-periodontitis/