Periodontal disease, tooth loss and incident rheumatoid arthritis: results from the First National Health and Nutrition Examination Survey and its epidemiological follow-up study

Abstract

Aims: Infection may be a rheumatoid arthritis (RA) risk factor. We examined whether signs of periodontal infection were associated with RA development in the First National Health and Nutrition Examination Survey and its epidemiological follow-up study.

Material and methods: In 1971-1974, 9702 men and women aged 25-74 were enrolled and surveyed longitudinally (1982, 1986, 1987, 1992). Periodontal infection was defined by baseline tooth loss or clinical evidence of periodontal disease. Baseline (n = 138) and incident (n = 433) RA cases were defined via self-report physician diagnosis, joint pain/swelling, ICD-9 codes (714.0-714.9), death certificates and/or RA hospitalization.

Results: Adjusted odds ratios (ORs) (95% CI) for prevalent RA in gingivitis and periodontitis (versus healthy) were 1.09 (0.57, 2.10) and 1.85 (0.95, 3.63); incident RA ORs were 1.32 (0.85, 2.06) and 1.00 (0.68, 1.48). The ORs for prevalent RA among participants missing 5-8, 9-14, 15-31 or 32 teeth (versus 0-4 teeth) were 1.74 (1.03, 2.95), 1.82 (0.81, 4.10), 1.45 (0.62, 3.41) and 1.30 (0.48, 3.53); ORs for incident RA were 1.12 (0.77, 1.64), 1.67 (1.12, 2.48), 1.40 (0.85, 2.33) and 1.22 (0.75, 2.00). Dose-responsiveness was enhanced among never smokers. The rate of death or loss-to-follow-up after 1982 was two- to fourfold higher among participants with periodontitis or missing ≥9 teeth (versus healthy participants).

Conclusions: Although participants with periodontal disease or ≥5 missing teeth experienced higher odds of prevalent/incident RA, most ORs were non-statistically significant and lacked dose-responsiveness. Differential RA ascertainment bias complicated the interpretation of these data.

Figure 1

Association between Baseline Tooth Loss and Incident Rheumatoid Arthritis According to Periodontal Status: Longitudinal Results from The First National Health and Nutrition Examination Survey and Its Epidemiologic Follow-up Study (n=7,008; 302 RA cases, p for interaction = 0.05). Adjusted for age, sex, race, education, smoking status. body mass index, physical activity, poverty index. PI=mean periodontal index±standard error per periodontal status category; MT=missing teeth. All tooth loss odds ratios are in reference to 0–4 MT within each periodontal status category. The OR comparing participants with gingivitis and 9–14 missing teeth to 0–4 missing teeth was statistically significant (p<0.05). All remaining comparisons for any tooth loss category vs. the reference (0–4 missing teeth) have p>0.05.