Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis

Abstract

Periodontitis is an inflammatory disease of dental supporting tissues (gingiva, periodontal ligament, and bone) and it has been suggested as a possible etiology for rheumatoid arthritis (RA). In this systematic review, we aim to verify if periodontitis represents a risk factor for RA. Electronic databases were consulted until March 2018 considering eligibility criteria focusing on: (P, participants) adults; (E, exposure) with periodontitis; (C, comparison) without periodontitis; and (O, outcome) development of RA. Quality assessment of studies and risk-of-bias evaluation were also performed. To undertake a quantitative analysis, the number of persons with RA and a total number of participants for the case group (with periodontitis) and control group (without periodontitis) were used to calculate the odds ratio (OR) with a 95% confidence interval (CI). A total of 3888 articles were identified, and nine studies were considered eligible. Seven of 9 articles suggested an association among diseases by the common pro-inflammatory profiles. The pooled analysis of 3 articles showed a higher RA prevalence for persons with periodontitis ( n = 1177) than controls ( n = 254) (OR 1.97; CI 1.68–2.31; p < 0.00001). However, considerable heterogeneity among studies was verified (I2 = 96%, p < 0.00001). Periodontitis may represent a risk factor for RA by heredity, bacterial infection, and the pro-inflammatory profile shared between both diseases. Although most of the elective studies report an association between periodontitis and RA, the quantitative analysis showed a high heterogeneity, leading to the need for further studies.

Ethanol binge drinking exposure affects alveolar bone quality and aggravates bone loss in experimentally-induced periodontitis

“…In the present investigation, we verified that intense and sporadic alcohol intake promoted changes in quality and density of alveolar bone alone and in association with ligature-induced periodontitis. The 3 days On- 4 days-Off ethanol (3g/kg/day) protocol has been tested in animal model, the results demonstrated that it is a valid way to simulate binge drinking [ 24 – 26 ]. Binge drinking protocol has been widely used for investigation related to bone tissue alterations provoked by alcohol intake in a rat model.…”

Porphyromonas gingivalis and Its Systemic Impact: Current Status

“…As a chronic autoimmune disease, rheumatoid arthritis (RA) is characterized by persistent inflammatory synovitis and progressive degeneration of cartilage and bone. A meta-analysis found a higher RA prevalence in periodontitis patients compared with controls [ 142 ], and non-surgical periodontal therapy in individuals with RA and periodontitis was associated with improvements in markers of disease activity in RA [ 143 ]. Many periodontal bacteria, particularly P. gingivalis , were detected in synovial fluid from patients with RA at the DNA level (42.1%) [ 144 ].…”

Association Between Diabetic Retinopathy and Periodontitis—A Systematic Review

“…Bidirectional interference has been also reported ( 7 ). The chronic bacterial challenge resulting from periodontitis is a persistent source of inflammatory mediators ( 8 ) that might interfere directly and indirectly in several systems ( 9 , 10 ) and promote effects in diabetes as insulin resistance, being able to increase the onset of diabetes complications ( 7 , 11 ).…”