Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Front Immunol. 2022 Jul 25;13:909783. doi: 10.3389/fimmu.2022.909783. eCollection 2022.
To identify the relationship between osteoarthritis and periodontitis.
144,788 periodontitis patients and 144,788 propensity score-matched controls without history of periodontitis were enrolled in this cohort study. A Cox proportional hazard model was used to estimate the risk of osteoarthritis. Survival analysis was utilized to assess the time-dependent effect of periodontitis on osteoarthritis. Age and gender were stratified to identify subgroups at risk. A symmetrical case-control analysis was designed to determine the relationship between present periodontitis and history of osteoarthritis.
Patients with periodontitis had higher risk of osteoarthritis (hazard ratio, HR =1.15, 95% CI =1.12-1.17, p < 0.001) and severe osteoarthritis that led to total knee replacement or total hip replacement (TKR/THR) (HR =1.12, 95% CI =1.03-1.21, p < 0.01) than controls, which was time-dependent (log-rank test p < 0.01). The effect of periodontitis on osteoarthritis was significant in both genders and age subgroups over 30 years-old (all p < 0.001). Among them, females (HR=1.27, 95% CI = 1.13-1.42, p < 0.001) and patients aged over 51 (HR= 1.21, 95% CI =1.10-1.33, p < 0.001) with periodontitis were predisposed to severe osteoarthritis. In addition, periodontitis patients were more likely to have a history of osteoarthritis (odds ratio = 1.11, 95% CI = 1.06 - 1.17, p < 0.001).
These findings suggest an association between periodontitis and a higher risk of osteoarthritis, including severe osteoarthritis that led to TKR/THR. Likewise, periodontitis is more likely to develop following osteoarthritis. A bidirectional relationship between osteoarthritis and periodontitis was observed.
确定骨关节炎与牙周炎之间的关系。
本队列研究纳入了 144788 例牙周炎患者和 144788 名无牙周炎病史的倾向评分匹配对照者。采用 Cox 比例风险模型估计骨关节炎的风险。采用生存分析评估牙周炎对骨关节炎的时变影响。对年龄和性别进行分层，以确定处于危险中的亚组。设计了一个对称病例对照分析，以确定现患牙周炎与既往骨关节炎之间的关系。
与对照组相比，患有牙周炎的患者发生骨关节炎（风险比，HR=1.15，95%CI=1.12-1.17，p<0.001）和导致全膝关节置换或全髋关节置换（TKR/THR）的严重骨关节炎（HR=1.12，95%CI=1.03-1.21，p<0.01）的风险更高，且呈时变趋势（对数秩检验，p<0.01）。牙周炎对骨关节炎的影响在所有年龄和性别亚组中均具有统计学意义（均 p<0.001）。其中，女性（HR=1.27，95%CI=1.13-1.42，p<0.001）和年龄>51 岁的患者（HR=1.21，95%CI=1.10-1.33，p<0.001）发生严重骨关节炎的风险更高。此外，牙周炎患者既往有骨关节炎病史的可能性更大（比值比=1.11，95%CI=1.06-1.17，p<0.001）。
这些发现表明牙周炎与骨关节炎风险增加相关，包括导致 TKR/THR 的严重骨关节炎。同样，骨关节炎后更易发生牙周炎。骨关节炎和牙周炎之间存在双向关系。
