To analyze the effect of tooth loss/periodontitis on disease activity in early and established RA.
Participants of the CAPEA early arthritis cohort reported their number of teeth at baseline. The number of teeth had been validated as predictor of periodontitis. Clinical endpoints including disease activity score (DAS28-ESR), swollen joint count (SJC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected at baseline, 3, 6, 12, 18, and 24 months. We used linear mixed regression models to estimate the association between tooth loss and clinical endpoints over time in early arthritis. For established RA, we analysed cross-sectional data from the German National Database (NDB). All models accounted for age, sex, smoking, seropositivity, education level, and disease duration (only NDB).
Among 1,124 CAPEA participants with early arthritis, those with higher tooth loss were older, more often male, smokers, seropositive, and they had higher disease activity and inflammation markers at baseline. Tooth loss was associated with higher disease activity and ESR values over time. Inflammatory markers decreased comparably across tooth loss categories. Glucocorticoid use was higher among those with more tooth loss while dose reduction was similar across tooth loss categories. Among 7,179 NDB participants with longstanding RA, disease activity and inflammation markers but not SJC were significantly higher in patients with more tooth loss.
While we observed an association between tooth loss and disease activity scores and inflammation markers in early and established RA, longitudinal results suggest that tooth loss does not hamper treatment response.