Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis

Abstract

Periodontitis is an inflammatory disease of dental supporting tissues (gingiva, periodontal ligament, and bone) and it has been suggested as a possible etiology for rheumatoid arthritis (RA). In this systematic review, we aim to verify if periodontitis represents a risk factor for RA. Electronic databases were consulted until March 2018 considering eligibility criteria focusing on: (P, participants) adults; (E, exposure) with periodontitis; (C, comparison) without periodontitis; and (O, outcome) development of RA. Quality assessment of studies and risk-of-bias evaluation were also performed. To undertake a quantitative analysis, the number of persons with RA and a total number of participants for the case group (with periodontitis) and control group (without periodontitis) were used to calculate the odds ratio (OR) with a 95% confidence interval (CI). A total of 3888 articles were identified, and nine studies were considered eligible. Seven of 9 articles suggested an association among diseases by the common pro-inflammatory profiles. The pooled analysis of 3 articles showed a higher RA prevalence for persons with periodontitis (n = 1177) than controls (n = 254) (OR 1.97; CI 1.68-2.31; p < 0.00001). However, considerable heterogeneity among studies was verified (I² = 96%, p < 0.00001). Periodontitis may represent a risk factor for RA by heredity, bacterial infection, and the pro-inflammatory profile shared between both diseases. Although most of the elective studies report an association between periodontitis and RA, the quantitative analysis showed a high heterogeneity, leading to the need for further studies.

Keywords: periodontitis; rheumatoid arthritis; systematic review.

Figure 1.

Flow diagram of databases searched according to PRISMA guidelines. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis.

Figure 2.

Forest plot of meta-analysis for three studies (I² = 96%). The association between periodontitis and RA. CI, confidence interval; M-H, Mantel-Haenszel method; RA, rheumatoid arthritis.

Figure 3.

Forest plot of meta-analysis for two studies (I² = 69%). The association between periodontitis and RA. CI, confidence interval; M-H, Mantel-Haenszel method; RA, rheumatoid arthritis.