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Investigating the relationship between the severity of periodontitis and rheumatoid arthritis: a cross-sectional study

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Abstract

Objectives

This paper evaluates the prevalence and severity of periodontitis (PD) in patients with rheumatoid arthritis (RA), focusing on the link between the severity of PD with RA disease activity/disability scores, the influence of RA treatment on PD, and levels of vitamin D.

Methods

A total of 93 RA patients were enrolled in the cross-sectional study and analyzed accordingly as RA-PD (N = 63, 67.8%) and RA-only (N = 30, 32.2%) groups. A number of associations between rheumatological clinical data, i.e., Disease Activity Score (DAS28 CRP), health assessment questionnaires, and PD severity (measured by periodontal outcome parameters) with regard to serum levels of vitamin D were assessed. The outcome variables were compared by parametric and non-parametric tests.

Results

A total of 29% of RA patients were diagnosed with severe PD. The RA-PD group presented a higher mean DAS28 CRP score in moderate–severe PD compared to periodontally healthy-initial stage PD subjects (4.49 ± 1.22 vs. 3.86 ± 1.58, p = 0.033). RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) were less likely to be diagnosed with PD (p = 0.022) and revealed significantly lower PD outcome parameters, i.e., bleeding on probing (%) and bone loss (%) (p < 0.05). Vitamin D concentration was significantly lower in RA-PD group with diagnosed advanced severe PD (IV stage) compared to moderate PD (II stage) (39.61 ± 17.12 vs. 52.07 ± 18.23 nmol/l, p = 0.031).

Conclusions

The study revealed a high prevalence of severe PD in RA patients, being significantly associated with higher RA disease activity and lower vitamin D level in RA-PD group, while bDMARD treatment was related to lower PD outcome parameters.

Key Points

• Severe PD is prevalent amongst RA patients and is associated with RA disease activity. The higher RA DAS28 CRP score is associated with moderate-severe PD compared to periodontally healthy-initial stage PD in RA patients.

• Biologic DMARDs treatment used for RA is linked to lower PD rates and PD outcome parameters.

• Significantly lower vitamin D level is found in advanced severe PD compared to moderate PD stage in RA-PD subjects.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

  • 18 March 2021

    The Funding Grant Number of this article has been updated.

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Funding

This project received funding from the European Regional Development Fund (project no. 01.2.2-LMT-K-718-01-0023) under a grant agreement with the Research Council of Lithuania (LMTLT).

Author information

Authors and Affiliations

  1. Clinic of Rheumatology, Traumatology Orthopaedics and Reconstructive Surgery, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Egle Punceviciene & Irena Butrimiene

  2. Centre of Rheumatology, Vilnius University Hospital Santaros klinikos, Santariškių str. 2, LT-08661, Vilnius, Lithuania

    Egle Punceviciene & Irena Butrimiene

  3. State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania

    Egle Punceviciene & Irena Butrimiene

  4. Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Adomas Rovas & Alina Puriene

  5. Vilnius University Hospital Zalgiris Clinic, Vilnius, Lithuania

    Adomas Rovas & Alina Puriene

  6. Institute of Biosciences, Life Sciences Centre, Vilnius University, Vilnius, Lithuania

    Kristina Stuopelyte & Sonata Jarmalaite

  7. National Cancer Institute, Vilnius, Lithuania

    Kristina Stuopelyte & Sonata Jarmalaite

  8. Institute of Biomedical Sciences of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Dalius Vitkus

  9. Centre of Laboratory Medicine, Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania

    Dalius Vitkus

Authors
  1. Egle Punceviciene
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  2. Adomas Rovas
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  3. Alina Puriene
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  4. Kristina Stuopelyte
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  5. Dalius Vitkus
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Punceviciene Egle, Rovas Adomas, and Stuopelyte Kristina. The first draft of the manuscript was written by Punceviciene Egle, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Egle Punceviciene.

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Ethics approval

Biomedical research is approved by Vilnius Regional Biomedical Research Ethics Committee, No. 158200-18-922-500. Informed consent was obtained from all participants. The research was carried out in accordance with the principles of the Declaration of Helsinki of 1975, revised in 2013.

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Punceviciene, E., Rovas, A., Puriene, A. et al. Investigating the relationship between the severity of periodontitis and rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 40, 3153–3160 (2021). https://doi.org/10.1007/s10067-021-05661-3

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