Impact of Biologic and Disease-Modifying Anti-rheumatic Drug (DMARD) Therapies on Oral Health in Rheumatologic Patients: A Case-Control Study.

BACKGROUND

Disease-modifying anti-rheumatoid drugs (DMARDs) and biological therapies are known to alter immune function, which may increase the risk of oral infections and mucosal changes. Immunosuppression induced by these medications can make patients more susceptible to conditions like oral candidiasis. Furthermore, there is limited research exploring the long-term oral health outcomes associated with these treatments, particularly in rheumatologic patients who are already at a higher risk of systemic inflammation. This study aims to address these gaps by assessing the impact of these therapies on oral health status and quality of life.

OBJECTIVES

This case-control study assesses oral health in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis receiving DMARD or biologic therapy.

PATIENTS AND METHODS

One hundred and fifty individuals were examined (50 cases on biological therapy, 50 cases on DMARDs, and 50 controls). Individuals undergoing systemic/biologic therapy for rheumatologic diseases were enlisted from outpatient clinics at Rizgary Teaching Hospital in Erbil, Iraq. All participants underwent a standardized oral health (OH) and quality of life (QoL) assessment following the World Health Organization (WHO) guidelines, which included both a questionnaire and an OH examination. Controls (healthy individuals) matched for age and sex were recruited from Khanzad Specialized Dental Teaching Center in Erbil, Iraq. The OH documentation of patients with rheumatologic diseases was recorded through oral examinations and medical chart reviews, which also included an assessment of the disease activity of each rheumatoid disease.

RESULT

Comparative analysis of OH behaviors showed significant differences between the groups. Patients receiving biologic therapies reported a lower frequency of regular dental check-ups compared to the DMARD and control groups (p < 0.05). Additionally, the use of interdental cleaning aids was less common among biological therapy patients, which may have contributed to the higher prevalence of periodontal issues observed in this group. Oral mucosal lesions (OML) were most prevalent in the DMARDs group with 37 participants (74%), followed by the biological group with 34 participants (68%), and least in the control group with 16 participants (32%) (p < 0.001). Dry mouth affected 38 participants (76%) in the biological group, 28 participants (52%) in the DMARDs group, and eight participants (16%) in the control group (p < 0.001). The DMARDs group also exhibited a significantly higher incidence of decayed and missing teeth compared to the biological and control groups (p = 0.002 and p = 0.008, respectively). In the biological group, the most common OMLs were candidiasis in 11 participants (22%) and ulceration in nine participants (18%), while in the DMARDs group, candidiasis affected 12 participants (24%) and ulceration affected seven participants (14%).

CONCLUSION

Patients with rheumatologic disease have poorer OH and OH-related QoL, more dry mouth, more decay, and missing teeth compared to control. Regarding OML, patients with rheumatologic disease are more susceptible to candidiasis. The findings indicate a need for routine OH monitoring and preventive strategies in these patient populations.