Periodontal Condition in Patients with Rheumatoid Arthritis: Effect of Anti-rheumatic Drugs

Kordtabar, Samira; Aghaie, Mehrdad; Fakhari, Elham; Vakili, Mohammad Ali

doi:10.30476/dentjods.2019.44914

Periodontal Condition in Patients with Rheumatoid Arthritis: Effect of Anti-rheumatic Drugs

Document Type : Original Article

Authors

Samira Kordtabar ¹

Mehrdad Aghaie ²

Elham Fakhari ³

Mohammad Ali Vakili ⁴

¹ Dental student, Golestan University of Medical Sciences, Gorgan, Iran.

² Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran.

³ Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran.

⁴ Health Management and Social Development Research Center, Dept. of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran.

https://doi.org/10.30476/dentjods.2019.44914

Abstract

Statement of the Problem: Rheumatoid arthritis and periodontitis are chronic inflammatory diseases with a possible bidirectional relationship. This link may be affected by many factors like drug consumption.
Purpose: This study was designed to evaluate the periodontal condition in patients with rheumatoid arthritis, considering the effect of disease modifying anti-rheumatic drugs.
Materials and Method: This case-control study included 25 newly diagnosed rheumatoid arthritis patients with negative history of taking anti-rheumatic drugs, 25 patients who received anti-rheumatic drugs for more than three years and 50 healthy individuals as a control group. Periodontal indices, including plaque index, gingival index, probing depth, clinical attachment loss, and rheumatologic indices were recorded and compared between these groups.
Results: Rheumatoid arthritis patients were significantly more affected by periodontitis compared with healthy subjects (p = 0.006). There was no significant difference in rheumatologic indices between patients with and without periodontitis. Clinical attachment loss in old rheumatoid arthritis patients and gingival index in newly diagnosed ones were significantly more compared to the control group (p = 0.003 and p < 0.001 respectively). We could not find a linear relationship between the severity of rheumatoid arthritis and chronic periodontitis (p = 0.1, r= -0.224).
Conclusion: Periodontitis and clinical attachment loss were more in patients with rheumatoid arthritis than the healthy group, especially in drug consumers. Gingival index in patients without the history of consuming anti-rheumatic drugs was significantly higher than those who were drug consumers, indicating the effect of the medications on the signs of inflammation.

Keywords

Chronic periodontitis ● Disease modifying ● Anti

rheumatic drugs ● Rheumatoid Arthritis

1. Kobayashi T, Yoshie H. Host Responses in the Link Between Periodontitis and Rheumatoid Arthritis. Curr Oral Health Rep. 2015; 2: 1–8. [PMC free article] [PubMed] [Google Scholar]

2. Detert J, Pischon N, Burmester GR, Buttgereit F. The association between rheumatoid arthritis and periodontal disease. Arthritis Res Ther. 2010; 12: 218. [PMC free article] [PubMed] [Google Scholar]

3. Leech MT, Bartold PM. The association between rheumatoid arthritis and periodontitis. Best Pract Res Clin Rheumatol. 2015; 29: 189–201. [PubMed] [Google Scholar]

4. Rutger Persson G. Rheumatoid arthritis and periodontitis-inflammatory and infectious connections. Review of the literature. J Oral Microbiol. 2012; 4 doi: 10.3402/jom.v4i0.11829. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

5. Biyikoğlu B, Buduneli N, Kardeşler L, Aksu K, Pitkala M, Sorsa T. Gingival crevicular fluid MMP-8 and -13 and TIMP-1 levels in patients with rheumatoid arthritis and inflammatory periodontal disease. J Periodontol. 2009; 80: 1307–1314. [PubMed] [Google Scholar]

6. Castro-Santos P, Díaz-Peña R. Genetics of rheumatoid arthritis: a new boost is needed in Latin American populations. Rev Bras Reumatol Engl Ed. 2016; 56: 171–177. [PubMed] [Google Scholar]

7. Routsias JG, Goules JD, Goules A, Charalampakis G, Pikazis D. Autopathogenic correlation of periodontitis and rheumatoid arthritis. Rheumatology (Oxford) 2011; 50: 1189–1193. [PubMed] [Google Scholar]

8. Han JY, Reynolds MA. Effect of anti-rheumatic agents on periodontal parameters and biomarkers of inflammation: a systematic review and meta-analysis. J Periodontal Implant Sci. 2012; 42: 3–12. [PMC free article] [PubMed] [Google Scholar]

9. Eriksson K, Nise L, Kats A, Luttropp E, Catrina AI, Askling J, et al. Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis: A Swedish Population Based Case-Control Study. PLoS One. 2016; 11: e0155956. [PMC free article] [PubMed] [Google Scholar]

10. Nilsson M, Kopp S. Gingivitis and periodontitis are related to repeated high levels of circulating tumor necrosis factor-alpha in patients with rheumatoid arthritis. J Periodontol. 2008; 79: 1689–1696. [PubMed] [Google Scholar]

11. Bıyıkoğlu B, Buduneli N, Kardeşler L, Aksu K, Pitkala M, Sorsa T. Gingival Crevicular Fluid MMP‐8 and- 13 and TIMP‐1 Levels in Patients With Rheumatoid Arthritis and Inflammatory Periodontal Disease. J Periodontol. 2009; 80: 1307–1314. [PubMed] [Google Scholar]

12. Dissick A, Redman RS, Jones M, Rangan BV, Reimold A, Griffiths GR, et al. Association of periodontitis with rheumatoid arthritis: a pilot study. J Periodontol. 2010; 81: 223–230. [PubMed] [Google Scholar]

13. Ziebolz D, Pabel SO, Lange K, Krohn-Grimberghe B, Hornecker E, Mausberg RF. Clinical periodontal and microbiologic parameters in patients with rheumatoid arthritis. J Periodontol. 2011; 82: 1424–1432. [PubMed] [Google Scholar]

14. Bakhtiari S, Taheri J, Abbasi F. Association between rheumatoid arthritis and moderate to severe periodontitis in Iranian adults. Journal of Dentistry of Tehran University of Medical Sciences. 2009; 6: 145–149. [Google Scholar]

15. 1999 International International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30-November 2, 1999 . Ann Periodontol. 1999; 4: 1–112. [PubMed] [Google Scholar]

16. DeVore CH, Beck FM, Horton JE. Plaque score changes based primarily on patient performance at specific time intervals. J Periodontol. 1990; 61: 343–346. [PubMed] [Google Scholar]

17. Loe H, Silness J. Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand. 1963; 21: 533–551. [PubMed] [Google Scholar]

18. Joseph R, Rajappan S, Nath SG, Paul BJ. Association between chronic periodontitis and rheumatoid arthritis: a hospital-based case-control study. Rheumatol Int. 2013; 33: 103–109. [PubMed] [Google Scholar]

19. Tengstrand B, Ahlmen M, Hafstrom I. The influence of sex on rheumatoid arthritis: a prospective study of onset and outcome after 2 years. J Rheumatol. 2004; 31: 214–222. [PubMed] [Google Scholar]

20. Khantisopon N, Louthrenoo W, Kasitanon N, Sivasomboon C, Wangkaew S, Sang-In S, et al. Periodontal disease in Thai patients with rheumatoid arthritis. Int J Rheum Dis. 2014; 17: 511–518. [PubMed] [Google Scholar]

21. Susanto H, Nesse W, Kertia N, Soeroso J, Huijser van Reenen Y, Hoedemaker E, et al. Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. J Periodontol. 2013; 84: 1067–1074. [PubMed] [Google Scholar]

22. Kasser UR, Gleissner C, Dehne F, Michel A, Willershausen-Zonnchen B, Bolten WW. Risk for periodontal disease in patients with longstanding rheumatoid arthritis. Arthritis Rheum. 1997; 40: 2248–2251. [PubMed] [Google Scholar]

23. De Smit M, Westra J, Vissink A, Doornbosvan der Meer B, Brouwer E, van Winkelhoff AJ. Periodontitis in established rheumatoid arthritis patients: a cross-sectional clinical, microbiological and serological study. Arthritis Res Ther. 2012; 14: R222. [PMC free article] [PubMed] [Google Scholar]

24. Reichert S, Machulla HK, Fuchs C, John V, Schaller HG, Stein J. Is there a relationship between juvenile idiopathic arthritis and periodontitis? . J Clin Periodontol. 2006;33:317–323. [PubMed] [Google Scholar]

25. Ishi Ede P, Bertolo MB, Rossa C, Kirkwood KL, Onofre MA. Periodontal condition in patients with rheumatoid arthritis. Braz Oral Res. 2008; 22: 72–77. [PubMed] [Google Scholar]

26. Torkzaban P, Hjiabadi T, Basiri Z, Poorolajal J. Effect of rheumatoid arthritis on periodontitis: a historical cohort study. J Periodontal Implant Sci. 2012; 42: 67–72. [PMC free article] [PubMed] [Google Scholar]

27. Kaur S, White S, Bartold PM. Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res. 2013; 92: 399–408. [PubMed] [Google Scholar]