Zhang Jiatong, Liu Xinyue, He Guiying, Qiu Zhengjie, Yan Mengqing, Zhang Mingxuan, Wu Dongyang, Ding Cheng, Liu Lipei, Chen Xing
Stomatology Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China; School of Stomatology, Hangzhou Normal University, Hangzhou, Zhejiang Province, China.
Stomatology Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China; School of Stomatology, Hangzhou Normal University, Hangzhou, Zhejiang Province, China.
J Endod. 2025 Jul;51(7):920-930. doi: 10.1016/j.joen.2025.04.013. Epub 2025 Apr 25.
Several clinical trials have investigated the relationship between rheumatoid arthritis (RA) and periapical periodontitis (AP), yielding inconsistent results. Our study aimed to synthesize clinical evidence through a meta-analysis and evaluate potential association using two-sample Mendelian randomization (TSM), which leverages genetic information for a more comprehensive perspective.
A systematic literature search was executed across PubMed, Web of Science, Scopus, and gray literature sources until February 20, 2025. Studies comparing radiolucent periapical lesions in RA patients with controls were qualified for this meta-analysis. Genetic data from genome-wide association studies of European populations with RA were used to scrutinize the relationships with diseases of pulp and periapical tissues, particularly chronic periapical periodontitis and pulpitis, employing a TSMR approach. Our primary estimates used the radial inverse-variance weighted method complemented by a series of sensitivity analyses to ensure robustness. MR-Egger intercept, Cochran's Q statistical analysis, and I were used to assess the potential heterogeneity and pleiotropy.
The meta-analysis included 1,206 participants across 5 selected studies. No significant correlation was found between radiographically diagnosed AP and RA at the patient level (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 0.91-2.67, P = .10). However, AP prevalence was 1.67 times higher in RA patients compared to healthy individuals at the tooth level (OR = 1.67, 95% CI = 1.18-2.35, P < .01). Genetically, RA was correlated with an elevated risk of diseases of pulp and periapical tissues (OR = 1.05; 95% CI = 1.03-1.07; P < .0000), chronic periapical periodontitis (OR = 1.05; 95% CI = 1.02-1.08; P = .0006) and pulpitis (OR = 1.01; 95% CI = 1.00-1.02; P = .0175), respectively.
Evidence from both the meta-analysis and the TSMR study moderately corroborates the associations between RA and pulpal-periapical diseases. Further research employing both human and animal models are recommended to confirm this link and elucidate potential underlying mechanisms.
多项临床试验研究了类风湿性关节炎（RA）与根尖周炎（AP）之间的关系，但结果并不一致。我们的研究旨在通过荟萃分析综合临床证据，并使用两样本孟德尔随机化（TSM）评估潜在关联，该方法利用遗传信息以获得更全面的视角。
在PubMed、Web of Science、Scopus和灰色文献来源中进行了系统的文献检索，直至2025年2月20日。比较RA患者与对照组中根尖周透射性病变的研究符合本荟萃分析的条件。来自欧洲人群RA全基因组关联研究的遗传数据用于通过TSMR方法研究与牙髓和根尖周组织疾病，特别是慢性根尖周炎和牙髓炎的关系。我们的主要估计采用径向逆方差加权法，并辅以一系列敏感性分析以确保稳健性。MR-Egger截距、Cochran's Q统计分析和I用于评估潜在的异质性和多效性。
荟萃分析纳入了5项选定研究中的1206名参与者。在患者层面，影像学诊断的AP与RA之间未发现显著相关性（优势比[OR]=1.56，95%置信区间[CI]=0.91-2.67，P=0.10）。然而，在牙齿层面，RA患者的AP患病率比健康个体高1.67倍（OR=1.67，95%CI=1.18-2.35，P<0.01）。在遗传方面，RA与牙髓和根尖周组织疾病（OR=1.05；95%CI=1.03-1.07；P<0.0000）、慢性根尖周炎（OR=1.05；95%CI=1.02-1.08；P=0.0006）和牙髓炎（OR=1.01；95%CI=1.00-1.02；P=0.0175）的风险升高相关。
荟萃分析和TSMR研究的证据均适度证实了RA与牙髓-根尖周疾病之间的关联。建议采用人类和动物模型进行进一步研究，以证实这种联系并阐明潜在的潜在机制。
