Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population

Abstract

Objectives: To investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health.

Design: Prospective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16 months later. Controls were examined once.

Settings and participants: The study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) naїve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants.

Outcome measures: Degree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria.

Results: Moderate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth ≥4 mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results.

Conclusions: Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.

Keywords: Arthritis; Inflammation; Periodontitis; Porphyromonas gingivalis; Rheumatoid.

Figure 1

Study protocol. CRA, chronic rheumatoid arthritis; ERA, early rheumatoid arthritis; RA, rheumatoid arthritis.

Figure 2

Number of sites with PD≥4 mm and periodontopathic bacteria in RA groups and controls. The symbols show individual participants with group medians denoted by horizontal lines. The groups were compared using Mann-Whitney test. The dental plaque culture for Porphyromonas gingivalis was positive in 11 participants (21.2%) in the early RA group at baseline, compared with 3 participants (7.0%) in the control group (p=0.009, χ² test). The number of cases positive for P. gingivalis in chronic RA group was 0. PD, periodontal pocket depth; RA, rheumatoid arthritis.