Background/Purpose: Recent clinical-epidemiological data suggest that periodontitis (P) shows higher prevalence in rheumatoid arthritis (RA) patients. However, due to the scarcity of epidemiological studies, the strength of association is limited, with odds ratios (OR) ranging from 1.82-8.05. The prevalence of P in the adult Spanish population¹ varies from 16 -30%,with a lower prevalence of severe P (5-11%). Nevertheless, the prevalence of P in Spanish RA patients is unknown. Our purpose is: 1.To determine the prevalence of P and its association in RA patients in our reference area.2.To describe the characteristics of P in RA patients.

Methods: Observational, descriptive, cross-sectional, case-control study of RA patients > 18 years old (ACR/EULAR 2010) in a hospital Rheumatology Department, and a control group with non-inflammatory joint disease, who had at least 4 teeth, had not received dental prophylaxis or antibiotics 6 months before the study. Socio-demographic and anthropometric variables included were body mass index, smoking status, Graffar scale, stress level, annual dental prophylaxis, and co-morbidities such as osteoporosis (OP), diabetes mellitus (DM), dyslipidemia (DS), arterial hypertension, ischemic cardiovascular disease (ICD). Periodontal Variables: plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), recession (REC), clinical attachment level (CAL). The dental team: 2 periodontists, 2 general dentists and 1 dental hygienist with inter-observer variability<30%. Full mouth CAL, PPD and periapical x-rays were taken. CAL was classified according to the European Workshop in 2005 (Tonetti),into level 0 (absence), TL1 (mild), TL2 (severe).Statistical analysis with Stata 13.1 using Student´s t test , Kruskal Wallis and Chi-square test.

Results: 344 patients were included: 187 RA (147 F/40 M) and 157 controls (101F/56M). The two groups were similar in age 54.9 (17.9), BMI 27.8 (4.6), stress level, DM and ICD and different in gender (>nº of males in controls), socioeconomic status (lower level in RA patients), > nº of current and former smokers in the RA group (19.25%vs 8.92%/ 24.6%vs 11.46%),OP (23.45% RA vs 7.8%), DS (hypertriglyceridemia ) 11.23% RA vs 4.46% in controls. 182/187 RA patients had P (97. 33%) vs 104/157 (66.24%) with P in controls. Regarding severity P: TL1 in 52.41% RA vs 54.14%;TL2 in 44.92% RA patients vs 12.1% in controls (p<0.001), OR 18.55 (CI 95% 7.18-47.87),which was maintained after adjusting for confounders: OR 16.25 + 9.29 (95% CI 5.23 – 49.86). Moreover, RA patients had poor periodontal status with a dramatic increase in all periodontal parameters: PI, PPD, nº and percentage of PPD ≥5mm and BoP (p<0.001) compared with the control group.

Conclusion: 1.Our study showed a strong association between RA and periodontitis with an adjusted OR 16.25. 2. The prevalence of severe periodontitis was significantly greater in RA patients than controls or the general population. 3. There were no differences in the prevalence of mild periodontitis between groups. 4. With respect to severity, RA patients showed more severe periodontitis than controls.     References: 1Bravo-Pérez M C-PE. Encuesta de salud oral en España 2005.RCOE.11(4):409-56.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-and-periodontitis-association-and-characteristics-of-chronic-periodontitis/