Background
Patients and methods
Study population
Study variables
Outcome and exposure variables
Study design
Medical examination
Periodontal examination
Sample size and statistical analyses
Results
Characteristics of RA patients and controls
RA patients | Controls |
p
| |||
---|---|---|---|---|---|
N
| % |
N
| % | ||
Gender | |||||
Female | 147 | 78.61 | 101 | 64.33 | |
Male | 40 | 21.39 | 56 | 35.67 | |
Ratio female/male | 3.6 | 1.8 | 0.003* | ||
Mean (SD) age (years) | 54.4 (10.8) | 55.5 (23.7) | |||
Race | |||||
Caucasian | 182 | 97.33 | 152 | 96.81 | |
Diagnosis | |||||
Osteoarthritis | – | – | 118 | 75.15 | |
Back pain | – | – | 23 | 14.65 | |
Scapulohumeral peri-arthritis | – | – | 10 | 6.36 | |
Others | – | – | 6 | 3.84 | |
Graffar Scale | |||||
High | 13 | 6.95 | 25 | 15.92 | |
Medium | 34 | 18.18 | 48 | 30.57 | |
Low | 68 | 36.36 | 55 | 35.03 | |
Relative poverty | 63 | 33.69 | 28 | 17.83 | |
Extreme poverty | 8 | 4.28 | 0 | 0 | < 0.001* |
Annual dental prophylaxis | 80 | 43.01 | 90 | 57.32 | 0.008* |
Mean (SD) ESR (mm/h) | 26.03 (16.8) | 16.97 (12.92) | |||
Periodontally healthy (Level 0) | 21.80 (7.46) | 16.06 (8.98) | |||
Periodontitis (Level 1 + 2) | 25.86 (16.68) | 19.05 (15.40) | 0.022** | ||
Mean (SD) CRP (mg/L) | 5.14 (7.00) | 2.85 (4.03) | |||
Periodontally healthy (Level 0) | 4.43 (2.34) | 1.72 (1.08) | |||
Periodontitis (Level 1 + 2) | 4.86 (5.21) | 3.26 (4.83) | 0.069** | ||
Bone mineral density | |||||
Normal | 64 | 44.14 | 113 | 80.14 | |
Osteopenia | 47 | 32.41 | 16 | 11.35 | |
Osteoporosis | 34 | 23.45 | 11 | 7.8 | < 0.001* |
Tobacco | |||||
Never | 105 | 56.15 | 125 | 79.62 | |
Current | 36 | 19.25 | 14 | 8.92 | |
Former smoker | 46 | 24.6 | 18 | 11.46 | < 0.001* |
Stress | 50 | 27.03 | 46 | 29.30 | |
Diabetes | 23 | 12.3 | 13 | 8.33 | |
Type II | 19 | 10.16 | 12 | 7.64 | |
Dyslipidemia | 100 | 53.48 | 71 | 45.22 | |
Hypercholesterolemia | 51 | 27.27 | 56 | 35.67 | |
Hypertriglyceridemia | 21 | 11.23 | 7 | 4.46 | |
Mixed hyperlipidemia | 28 | 14.97 | 8 | 5.1 | < 0.001* |
Hypertension | 58 | 31.02 | 35 | 22.29 | |
Myocardial infarction | 8 | 4.28 | 3 | 1.92 | |
Mean (SD) BMI (kg/m2) | 27 (4.7) | 27.9 (4.4) | |||
Normal, 18.5–24.99 | 52 | 27.81 | 47 | 30.13 | |
Overweight, 25–29.99 | 79 | 42.25 | 71 | 45.51 | |
Obesity I, 30–34.99 | 46 | 24.6 | 28 | 17.95 |
N
| % | |
---|---|---|
Gender | ||
Female | 147 | 78.61 |
Male | 40 | 21.39 |
Mean (SD) age (years) | 54.4 (10.8) | |
Mean (SD) time evolution (years) | 8.88 (7.32) | |
Early RA | 35 | 18.72 |
Established RA | 152 | 81.28 |
Rheumatoid factor | ||
Seropositive | 138 | 74.19 |
Rheumatoid factor concentration (IU/ml) | ||
Low (≤ 90) | 49 | 36.84 |
Moderate (91–300) | 56 | 42.11 |
High (> 300) | 28 | 21.05 |
Anti-CCP | ||
Positive | 114 | 67.86 |
Anti-CCP concentration (U/ml) | ||
Low (≤ 75) | 30 | 27.27 |
Moderate (76–300) | 43 | 39.09 |
High (> 300) | 37 | 33.64 |
Level of activity, mean (SD) | ||
DAS28 | 3.81(1.31) | |
DAS28-CRP | 3.18(1.18) | |
SDAI | 14.49(10.74) | |
CDAI | 12.68(10.19) | |
Disease activity (combined index) | ||
Remission | 38 | 20.32 |
Low | 39 | 20.90 |
Moderate | 85 | 45.45 |
High | 25 | 13.43 |
HAQ | 0.760 (0.62) | |
Glucocorticoid therapy | ||
No glucocorticoids | 99 | 52.94 |
Glucocorticoids | 88 | 47.06 |
Current dosage GC, mean (SD) (mg/day) | 2.85 (4.24) | |
Low < 7.5 | 65 | 73.86 |
Moderate 7.5–20 | 22 | 25 |
High > 20 | 1 | 1.14 |
Type of RA therapy | ||
No treatment | 10 | 5.35 |
sDMARDs | 99 | 52.94 |
≥ 2 sDMARDs | 22 | 11.76 |
bDMARDs | 56 | 29.95 |
Prevalence and severity of periodontitis in RA and control patients
RA patients | Controls |
p
| |||||
---|---|---|---|---|---|---|---|
N
| % | Mean (SD) |
N
| % | Mean (SD) | ||
Periodontitisa | |||||||
Level 0 | 5 | 2.67 | 53 | 33.76 | < 0.001 | ||
Level 1 | 98 | 52.41 | 85 | 54.14 | |||
Level 2 | 84 | 44.92 | 19 | 12.1 | < 0.001 | ||
Level 1 + 2 | 182 | 97.33 | 104 | 66.24 | < 0.001 | ||
Periodontal variables | |||||||
Mean PI | 0.74 (0.48) | 0.56 (0.40) | < 0.001 | ||||
Mean PPD | 3.08 (0.63) | 2.69 (0.48) | < 0.001 | ||||
CAL | 3.99(1.27) | 3.34 (1.03) | < 0.001 | ||||
Tooth loss | 6.31 (5.28) | 4.01 (4.48) | < 0.001 | ||||
N° PPD ≥ 5 mm | 14.60 (17.03) | 6.37 (11.50) | < 0.001 | ||||
% PPD ≥ 5 mm | 0.12 (0.14) | 0.05 (0.08) | < 0.001 | ||||
% BoP | 0.63 (0.23) | 0.42 (0.26) | < 0.001 |
Factor | Bivariate | Multivariate | Multivariate Level 1 + 2 | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI |
p
| Adjusted OR | 95% CI |
p
| Adjusted OR | 95% CI |
p
| |
Periodontitis (ref. to no) | |||||||||
Level 1 | 12.22 | (4.67–31.98) | < 0.001 | 14.78 | (4.23–51.68) | < 0.001 | |||
Level 2 | 46.86 | (16.51–133) | < 0.001 | 81.01 | (18.59–353.07) | < 0.001 | |||
Level 1 + 2 | 14.75 | (5.66–34.4) | < 0.001 | 20.57 | (6.02–70.27) | < 0.001 | |||
Age | 1.00 | (0.98–1.01) | 0.564 | 0.95 | (0.92–0.98) | 0.003 | 0.96 | (0.93–0.99) | 0.003 |
Gender (ref. to woman) | 0.491 | (0.30–0.79) | 0.004 | 0.18 | (0.07–0.44) | < 0.001 | 0.23 | (0.10–0.54) | 0.001 |
Socioeconomic status (ref. to poverty(Ext + Rel)) | |||||||||
High | 0.20 | (0.09–0.46) | < 0.001 | 0.18 | (0.05–0.60) | 0.006 | 0.16 | (0.05–0.53) | 0.003 |
Medium | 0.28 | (0.15–0.52) | < 0.001 | 0.16 | (0.05–0.47) | 0.001 | 0.16 | (0.05–0.46) | 0.001 |
Low | 0.49 | (0.28–0.86) | 0.012 | 0.31 | (0.13–0.75) | 0.010 | 0.33 | (0.14–0.77) | 0.011 |
Annual dental prophylaxis (ref. to no) | 0.56 | (0.37–0.86) | 0.008 | 0.52 | (0.26–1.05) | 0.070 | 0.49 | (0.25–0.96) | 0.039 |
Osteoporosis (ref. to no) | |||||||||
Osteopenia | 5.19 | (2.72–9.88) | < 0.001 | 5.95 | (2.29–15.42) | < 0.001 | 5.26 | (2.18–12.65) | < 0.001 |
Osteoporosis | 5.46 | (2.59–11.50) | < 0.001 | 8.00 | (2.79–22.86) | < 0.001 | 6.91 | (2.53–18.90) | < 0.001 |
Smoking (ref. to no) | |||||||||
Smoker | 3.06 | (1.57–5.98) | 0.001 | 1.08 | (0.44–2.65) | 0.858 | 1.62 | (0.69–3.81) | 0.269 |
Former smoker | 3.04 | (1.66–5.56) | < 0.001 | 7.67 | (2.73–21.57) | < 0.001 | 8.03 | (2.93–22.02) | < 0.001 |
Stress (ref. to no) | 0.89 | (0.56–1.43) | 0.641 | 1.14 | (0.51–2.57) | 0.747 | 1.16 | (0.54–2.49) | 0.707 |
BMI (continuous) | 1.00 | (0.95–1.04) | 0.879 | 0.93 | (0.86–1.01) | 0.078 | 0.94 | (0.87–1.01) | 0.091 |
HTA (ref. to no) | 1.57 | (0.96–2.55) | 0.071 | 3.26 | (1.35–7.87) | 0.008 | 2.85 | (1.26–6.49) | 0.012 |
MI (ref. to no) | 2.28 | (0.59–8.74) | 0.230 | 2.63 | (0.38–18.42) | 0.330 | 2.84 | (0.40–20.24) | 0.298 |
Association between periodontitis and clinical activity, severity and treatment in RA patients
Estimation | SE |
p
| OR (95% CI) | |
---|---|---|---|---|
Bivariate model | ||||
Threshold | ||||
Remission | −0.969 | 0.210 | ||
Low | 0.099 | 0.193 | ||
Periodontitis = Level 2 (ref. to 0 + 1) | 1.105 | 0.308 | < 0.001 | 3.02 (1.65–5.52) |
Multivariate model | ||||
Threshold | ||||
Remission | −3.665 | 1.703 | ||
Low | −2.504 | 1.687 | ||
Periodontitis = Level 2 (ref. to 0 + 1) | 0.979 | 0.392 | 0.012 | 2.66 (1.24–5.74) |
Age | −0.042 | 0.022 | 0.060 | 0.96 (0.92–1.00) |
Gender = man (ref. to woman) | −1.225 | 0.520 | 0.019 | 0.29 (0.11–0.81) |
Socioeconomic status (ref. to poverty (Ext + Rel)) | ||||
High | −1.465 | 0.713 | 0.040 | 0.23 (0.06–0.94) |
Medium | −0.186 | 0.587 | 0.752 | 0.83 (0.26–2.63) |
Low | −0.138 | 0.431 | 0.749 | 0.87 (0.37–2.03) |
Annual dental prophylaxis = Yes (ref. to no) | −0.444 | 0.395 | 0.260 | 0.64 (0.30–1.39) |
Osteoporosis (ref. to no) | ||||
Osteopenia | 0.034 | 0.446 | 0.940 | 1.03 (0.43–2.48) |
Osteoporosis | 0.403 | 0.544 | 0.458 | 1.50 (0.52–4.35) |
Smoking (ref. to no) | ||||
Smoker | 0.303 | 0.537 | 0.572 | 1.35 (0.47–3.88) |
Former smoker | 0.086 | 0.460 | 0.851 | 1.09 (044–2.69) |
Stress = Yes (ref. to no) | 0.978 | 0.497 | 0.049 | 2.66 (1.00–7.04) |
BMI (continuous) | −0.011 | 0.043 | 0.800 | 0.99 (0.91–1.08) |
HTA = Yes (ref. to no) | 0.808 | 0.429 | 0.059 | 2.24 (0.97–5.20) |
MI = Yes (ref. to no) | 1.143 | 0.983 | 0.245 | 3.14 (0.46–21.51) |