1- Department of Oral and Maxillofacial Medicine, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
2- Department of Oral and Maxillofacial Pathology, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
3- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shahid Sadoughi University of Medical Science, Yazd, Iran ,f.owlia@ssu.ac.ir
4- Department of Restorative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Science, Yazd, Iran
2- Department of Oral and Maxillofacial Pathology, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
3- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shahid Sadoughi University of Medical Science, Yazd, Iran ,
4- Department of Restorative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Science, Yazd, Iran
Abstract: (2235 Views)
Background: Rheumatoid Arthritis (RA) is the most common chronic inflammatory joint disease. Previous studies have shown that periodontitis and RA have a probable bilateral relationship. This study aimed to investigate the association between periodontal indices and RA activity levels in RA activity levels and to compare these indices by disease status.
Methods: In this cross-sectional pilot study, 50 patients referred to the public rheumatology clinic who met the inclusion criteria were enrolled. They were allocated into three groups based on disease activity: inactive, active, and recurrent active rheumatoid arthritis. Periodontal indices, including bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD), tooth loss (TL), and rheumatologic indices, such as hemoglobin level, were recorded and compared between groups. Significance was set at a P-Value <0.05.
Results: No significant differences in demographic data, periodontal status, or laboratory parameters were found among the RA groups (p>0.05)., with the sole exception of the erythrocyte sedimentation rate (ESR), which showed a significant difference (p=0.016).
Conclusion: Unlike ESR, periodontal indices showed no significant differences across RA activity states. These findings are hypothesis-generating rather than definitive evidence of causality. Therefore, clinical recommendations linking periodontal status to RA activity should be made cautiously pending further longitudinal studies.
Methods: In this cross-sectional pilot study, 50 patients referred to the public rheumatology clinic who met the inclusion criteria were enrolled. They were allocated into three groups based on disease activity: inactive, active, and recurrent active rheumatoid arthritis. Periodontal indices, including bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD), tooth loss (TL), and rheumatologic indices, such as hemoglobin level, were recorded and compared between groups. Significance was set at a P-Value <0.05.
Results: No significant differences in demographic data, periodontal status, or laboratory parameters were found among the RA groups (p>0.05)., with the sole exception of the erythrocyte sedimentation rate (ESR), which showed a significant difference (p=0.016).
Conclusion: Unlike ESR, periodontal indices showed no significant differences across RA activity states. These findings are hypothesis-generating rather than definitive evidence of causality. Therefore, clinical recommendations linking periodontal status to RA activity should be made cautiously pending further longitudinal studies.
References
1. Dolcezza S, Flores-Fraile J, Lobo-Galindo AB, Montiel-Company JM, Zubizarreta-Macho Á. Relationship Between Rheumatoid Arthritis and Periodontal Disease-Systematic Review and Meta-Analysis. J Clin Med. 2024;14(1):10. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Jahid M, Khan KU, Rehan Ul H, Ahmed RS. Overview of Rheumatoid Arthritis and Scientific Understanding of the Disease. Mediterranean journal of rheumatology. 2023;34(3):284-91. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Łasica A, Golec P, Laskus A, Zalewska M, Gędaj M, Popowska M. Periodontitis: etiology, conventional treatments, and emerging bacteriophage and predatory bacteria therapies. Front Microbiol. 2024;15:1469414. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Huang X, Xie M, Xie Y, Mei F, Lu X, Li X, et al. The roles of osteocytes in alveolar bone destruction in periodontitis. J Transl Med. 2020;18(1):479. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Ishikawa Y, Terao C. The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review. Cells. 2020;9(2):475. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Mole EN, Tarassi K, Tsirogianni A, Athanassiades T, Kitsiou V, Kouniaki D, et al. Impact of HLA-DRB1 SE, anti-citrullinated protein antibodies and smoking on radiographic outcome in Greek patients with Rheumatoid Arthritis. BMC Rheumatol. 2025;9(1):128. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Zhao X, Liu Z, Shu D, Xiong Y, He M, Xu S, et al. Association of Periodontitis with Rheumatoid Arthritis and the Effect of Non-Surgical Periodontal Treatment on Disease Activity in Patients with Rheumatoid Arthritis. Med Sci Monit. 2018;24:5802-10. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Atarbashi-Moghadam F, Rashidi Maybodi F, Dehghan A, Haerian Ardakani A. Effect of non-surgical periodontal treatment on clinical signs of rheumatoid arthritis. J Adv Periodontol Implant Dent. 2018;10(1):13-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Kordtabar S, Aghaie M, Fakhari E, Vakili MA. Periodontal Condition in Patients with Rheumatoid Arthritis: Effect of Anti-rheumatic Drugs. J Dent (Shiraz). 2019;20(3):190-4. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Dissick A, Redman RS, Jones M, Rangan BV, Reimold A, Griffiths GR, et al. Association of periodontitis with rheumatoid arthritis: a pilot study. J Periodontol. 2010;81(2):223-30. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Fathi HM, Khairy N, Gheita TA, El Battawy WA, Taha R. Clinical significance of periodontitis in rheumatoid arthritis patients: association with disease activity and functional status. Journal of Arthritis. 2018;7(2):1-7. [View at Publisher] [DOI] [Google Scholar]
12. Detert J, Pischon N, Burmester GR, Buttgereit F. The association between rheumatoid arthritis and periodontal disease. Arthritis Res Ther. 2010;12(5):218. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Payne JB, Golub LM, Thiele GM, Mikuls TR. The link between periodontitis and rheumatoid arthritis: a periodontist's perspective. Curr Oral Health Rep. 2015;2(1):20-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Maybodi FR, Bashiri H, Sezavar K, Owlia F. Effect of periodontal treatment on serum inflammatory parameters and disease activity in patients with systemic lupus erythematosus: A randomized controlled trial. J Indian Soc Periodontol. 2022;26(6):564-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Schulz S, Pütz N, Jurianz E, Schaller HG, Reichert S. Are There Any Common Genetic Risk Markers for Rheumatoid Arthritis and Periodontal Diseases? A Case-Control Study. Mediators Inflamm. 2019;2019:2907062. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Renvert S, Berglund JS, Persson GR, Söderlin MK. The association between rheumatoid arthritis and periodontal disease in a population-based cross-sectional case-control study. BMC Rheumatol. 2020;4(1):31. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Pischon N, Pischon T, Kröger J, Gülmez E, Kleber BM, Bernimoulin JP, et al. Association among rheumatoid arthritis, oral hygiene, and periodontitis. J Periodontol. 2008;79(6):979-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, et al. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care Res (Hoboken). 2019;71(12):1540-55. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3-15. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Roodenrijs NMT, Kedves M, Hamar A, Nagy G, van Laar JM, van der Heijde D, et al. Diagnostic issues in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open. 2021;7(1):e001511. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Cetinkaya B, Guzeldemir E, Ogus E, Bulut S. Proinflammatory and anti‐inflammatory cytokines in gingival crevicular fluid and serum of patients with rheumatoid arthritis and patients with chronic periodontitis. J Periodontol. 2013;84(1):84-93. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Khantisopon N, Louthrenoo W, Kasitanon N, Sivasomboon C, Wangkaew S, Sang‐In S, et al. Periodontal disease in Thai patients with rheumatoid arthritis. Int J Rheum Dis. 2014;17(5):511-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Al-Jabi SW, Seleit DI, Badran A, Koni A, Zyoud SH. Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine. Health Qual Life Outcomes. 2021;19(1):241. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Shakeel L, Shaukat A, Khaliq N, Kashif A, Mujeeb A, Adnan Z, et al. Rheumatoid arthritis: a comprehensive overview of genetic markers, emerging therapies, and personalized medicine. Ann Med Surg (Lond). 2025;87(2):696-710. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Mohammadi.B.A A, Karami M, Nouri M, Morovati SP. Comparison of the efficiency of three tooth brushing training methods on dental plaque removal of 10-year-old female students. ijpd. 2022;17(1):1-11. [View at Publisher] [Google Scholar]
26. Cheng X, Liu J, Liu S, Fang D, Chen X, Ding X, et al. Red Blood Cell-Related Parameters in Rheumatoid Arthritis: Clinical Value and Immunological Significance. J Inflamm Res. 2024;17:10641-50. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Bosma ML, McGuire JA, DelSasso A, Milleman J, Milleman K. Efficacy of flossing and mouth rinsing regimens on plaque and gingivitis: a randomized clinical trial. BMC Oral Health. 2024;24(1):178. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43(1):38-. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Reyes-Castillo Z, Muñoz-Valle JF, Llamas-Covarrubias MA. Clinical and immunological aspects of anti-peptidylarginine deiminase type 4 (anti-PAD4) autoantibodies in rheumatoid arthritis. Autoimmun Rev. 2018;17(2):94-102. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Koziel J, Mydel P, Potempa J. The link between periodontal disease and rheumatoid arthritis: an updated review. Curr Rheumatol Rep. 2014;16(3):408. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to mouth: a systematic review and meta-analysis of the association between rheumatoid arthritis and periodontitis. Front Immunol. 2016;7:80. [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Kim J-W, Park J-B, Yim HW, Lee J, Kwok S-K, Ju JH, et al. Rheumatoid arthritis is associated with early tooth loss: results from Korea National Health and Nutrition Examination Survey V to VI. Korean J Intern Med. 2019;34(6):1381-91. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. de Molon RS, Rossa Jr C, Thurlings RM, Cirelli JA, Koenders MI. Linkage of periodontitis and rheumatoid arthritis: current evidence and potential biological interactions. Int J Mol Sci. 2019;20(18):4541. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Nasir N, Majid H, Khan AH, Awan S, Riaz MM. Disease activity correlates and functionality in patients with rheumatoid arthritis - real-world experience from a South Asian country. Reumatologia. 2022;60(3):183-91. [View at Publisher] [DOI] [PMID] [Google Scholar]
35. Zhang J, Wang Y, Nie W, Li Q, Li S-G, Jin D. CBC‑derived inflammatory indices for rheumatoid arthritis diagnosis and activity assessment: differential performance by serostatus. Front Immunol. 2026;17:1740898. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Almazroea AH, Yousef S, Ahmad SM, AlHiraky HN, Al-Haidose A, Abdallah AM. The Impact of ACE Gene Variants on Acute-Phase Reactants in Children with Rheumatic Heart Disease. Diagnostics. 2023;13(10):1672. [View at Publisher] [DOI] [PMID] [Google Scholar]
37. Leong KP, Tan JWL, Gao X, Koh ET. Conversion among the 28-joint count activity indices for rheumatoid arthritis. Eur J Rheumatol . 2020;7(3):105-11. [View at Publisher] [DOI] [PMID] [Google Scholar]
38. Bartold PM, Lopez‐Oliva I. Periodontitis and rheumatoid arthritis: an update 2012‐2017. Periodontol 2000. 2020;83(1):189-212. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Ceccarelli F, Saccucci M, Di Carlo G, Lucchetti R, Pilloni A, Pranno N, et al. Periodontitis and rheumatoid arthritis: the same inflammatory mediators? Mediators Inflamm. 2019:2019:6034546. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Pawłowska J, Smoleńska Z, Daca A, Witkowski JM, Bryl E. Older age of rheumatoid arthritis onset is associated with higher activation status of peripheral blood CD4(+) T cells and disease activity. Clin Exp Immunol. 2011;163(2):157-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
41. Rovas A, Puriene A, Punceviciene E, Butrimiene I, Stuopelyte K, Jarmalaite S. Associations of periodontal status in periodontitis and rheumatoid arthritis patients. J Periodontal Implant Sci. 2021;51(2):124-34. [View at Publisher] [DOI] [PMID] [Google Scholar]
42. Almashni H, Kakar E, Nava P, Wang HL, Saleh MHA. Influence of rheumatoid arthritis on peri-implant diseases: A longitudinal retrospective clinical and radiographic evaluation. J Periodontol. 2025;96(8):933-43. [View at Publisher] [DOI] [PMID] [Google Scholar]
43. Auyezkhankyzy D, Izekenova A, Kocyigit BF. Emergencies in inflammatory rheumatic diseases. Rheumatol Int. 2024;44(9):1637-46. [View at Publisher] [DOI] [PMID] [Google Scholar]
44. Nik-Azis N-M, Mohd N, Baharin B, Said MSM, Fadzilah FM, Haflah NHM. Periodontal Disease in Seropositive Rheumatoid Arthritis: Scoping Review of the Epidemiological Evidence. Germs. 2021;11(2):266-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
45. Angiolani F, Gerardi D, Bernardi S, Torge D, Bianchi S, Piattelli M, et al. Bidirectional Relationship Between Periodontal Disease and Reproductive Disorders: Focus on Polycystic Ovary Syndrome. Oral. 2025;5(3):67. [View at Publisher] [DOI] [Google Scholar]
46. Ceraulo S, Barbarisi A, Caccianiga G, Lodico M, Cremonini F, Lauritano D, et al. A possible correlation between periodontal disease and systemic diseases: a clinical study. BMC Oral Health. 2025;26(1):13. [View at Publisher] [DOI] [PMID] [Google Scholar]
47. Wei W, Ren J, Yin W, Ding H, Lu Q, Tan L, et al. Inhibition of Ctsk modulates periodontitis with arthritis via downregulation of TLR9 and autophagy. Cell Prolif. 2020;53(1):e12722. [View at Publisher] [DOI] [PMID] [Google Scholar]
48. Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019;21(1):27 [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
