Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain.
Periodoncia, Facultad de Odontología, Universidad Complutense, Madrid, Spain.
Arthritis Res Ther. 2019 Jan 18;21(1):27. doi: 10.1186/s13075-019-1808-z.
A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity.
This case-control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR).
A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02-70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24-5.74, p = 0.012).
A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.
类风湿关节炎（RA）患者的牙周炎患病率较高，但其相关性的强度、时间关联以及牙周炎严重程度与 RA 疾病活动度之间的可能关系尚不清楚。本研究旨在探讨牙周炎是否与 RA 相关，以及牙周炎严重程度是否与 RA 疾病活动度相关。
本病例对照研究纳入了 187 例确诊为 RA 的患者和 157 例无炎症性关节疾病的对照患者。通过 28 关节疾病活动评分、简化疾病活动指数、临床疾病活动指数、类风湿因子、抗瓜氨酸蛋白抗体滴度、红细胞沉降率、C 反应蛋白、关节外表现以及 RA 治疗类型评估 RA 疾病活动和严重程度。通过以下牙周参数评估暴露严重程度：菌斑指数、探诊出血、探诊深度和临床附着水平。评估社会人口统计学变量和合并症作为混杂因素。通过参数和非参数检验比较结局和暴露变量，并通过回归分析评估可能的关联，计算调整后的比值比（OR）。
牙周炎与 RA 显著相关，调整后的 OR 为 20.57（95%CI 6.02-70.27，p<0.001）。与对照组相比，RA 患者所有与牙周状况相关的参数（菌斑指数、探诊出血、探诊深度和临床附着水平）均显著更差（p<0.001）。牙周炎严重程度与 RA 疾病活动度显著相关（p<0.001），在有序逻辑回归模型中，牙周严重程度与疾病活动度之间的关联调整后的 OR 为 2.66（95%CI 1.24-5.74，p=0.012）。
牙周炎与 RA 之间存在显著关联，与其他混杂因素无关。这种关联在牙周病严重和 RA 疾病活动度较高的患者中更为明显。
