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Activity of rheumatoid arthritis correlates with oral inflammatory burden

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Abstract

To study oral health in patients with rheumatoid arthritis (RA) with emphasis on disease activity and treatment of RA. In this prospective cohort study 81 RA patients [53 early untreated RA (EURA) and 28 chronic RA (CRA) patients with inadequate response to synthetic disease modifying antirheumatic drugs (DMARDs)], underwent rheumatological [Disease Activity Score (28-joint) DAS28] and dental examinations [Total Dental Index (TDI), Decayed Missing Filled Teeth (DMFT) and Decayed Missing Filled Surfaces (DMFS)]. For controls, 43 volunteers were examined. After the examinations, EURA patients started treatment with synthetic DMARDs, oral and intra-articular glucocorticoids. CRA patients were candidates for biological DMARDs. The patients were re-examined mean 16 months later. Results were analyzed with descriptive statistics and logistic regression. TDI was higher in both RA groups at baseline compared to controls [EURA: 2 (2–3); CRA: 2 (1–3); controls 1 (1–3), p = 0.045]. DMFT [rs 0.561 (p = 0.002)] and DMFS [rs 0.581 (p = 0.001)] associated with DAS28 at baseline in CRA patients. After follow-up, DAS28 associated positively with DMFT [rs 0.384 (p = 0.016)] and DMFS [rs 0.334 (p = 0.038)] in EURA patients; as well as in CRA patients DMFT [rs 0.672 (p = 0.001)], DMFS [rs 0.650 (p = 0.001)]. RA patients already in the early phase of the disease had poorer oral health compared to controls. The caries indices associated with the activity of RA in both patient groups. Oral status may thus contribute to the development and further relate to the activity of RA.

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Funding

The study was supported by National Graduate School of Musculosceletal Disorders and Biomaterials, by grants from the Helsinki University Hospital Research Funds (EVO-Grants TYH5231, TYH2008232, TYH2011115, TYH2013328, TYH2014225 and TYH2015119), The Medical Society of Finland (Finska Läkaresällskapet) and Liv och Hälsa. The authors thank the patients for participating in this study. Krista Kuuliala PhD, and study nurses Arja Kaarto and Anneli Sinkkonen are acknowledged for their skilled contribution.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland

    Leena Äyräväinen, Anna Maria Heikkinen, Kirsi Ahola & Jukka H. Meurman

  2. Department of Bacteriology and Immunology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

    Antti Kuuliala

  3. Department of Rheumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

    Riitta Koivuniemi & Marjatta Leirisalo-Repo

  4. Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

    Jaakko Peltola, Anni Suomalainen & Leena Laasonen

  5. The Immunopharmacology Research Group, Tampere University Hospital, University of Tampere School of Medicine, Tampere, Finland

    Eeva Moilanen & Mari Hämäläinen

Authors
  1. Leena Äyräväinen
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  2. Anna Maria Heikkinen
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  3. Antti Kuuliala
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  7. Anni Suomalainen
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  9. Mari Hämäläinen
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  11. Jukka H. Meurman
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  12. Marjatta Leirisalo-Repo
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Contributions

LÄ is the main investigator in this study which is part of her PhD studies. ML-R and RK recruited and performed the rheumatological examination of the patients, KA carried out dental examinations. JP, AS and LL analyzed the radiological data, and MH and EM analyzed IL-6 concentrations in plasma. AMH was involved in data analyses and preparing the manuscript, AK was involved in data acquisition, analyses and preparing the manuscript. ML-R and JHM were the PIs of the study design, analyses and in writing and critical evaluation of the manuscript. We did not use any external editing support.

Corresponding author

Correspondence to Leena Äyräväinen.

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Conflict of interest

Author Leena Äyräväinen, Author Anna Maria Heikkinen, Author Antti Kuuliala, Author Kirsi Ahola, Author Riitta Koivuniemi, Author Jaakko Peltola, Author Anni Suomalainen, Author Eeva Moilanen, Author Mari Hämäläinen, Author Leena Laasonen, Author Jukka H. Meurman and Author Marjatta Leirisalo-Repo declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Äyräväinen, L., Heikkinen, A.M., Kuuliala, A. et al. Activity of rheumatoid arthritis correlates with oral inflammatory burden. Rheumatol Int 38, 1661–1669 (2018). https://doi.org/10.1007/s00296-018-4108-z

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