BERLIN – Multiple tooth loss appears to be a marker for increased risk of subsequent rheumatoid arthritis – and the more missing teeth, the higher the arthritis disease activity and the worse the treatment response, according to studies presented at the annual European Congress of Rheumatology.
Tooth loss is considered a surrogate marker for periodontitis, a common chronic inflammatory process involving the gums and other tooth-supporting structures. Investigators are increasingly interested in exploring a possible causal relationship between this oral disease and chronic diseases elsewhere in the body having a prominent systemic inflammatory component, including coronary artery disease and rheumatoid arthritis (RA).
Dr. Gisela Westhoff reported on 540 patients with early arthritis participating in the ongoing observational CAPEA (Course and Prognosis of Early Arthritis) study. Patients averaged 56 years of age, with a mean symptom duration of 13 weeks at enrollment. A total of 59% were negative for rheumatoid factor and/or positive for anti–citrullinated protein antibody, 67% met current diagnostic criteria for RA, and 87% were on disease-modifying antirheumatic drugs.
At 6 months, 52% of the patients achieved a good response to treatment according to EULAR response criteria. Another 32% had a moderate response, and 16% had no response.
Patients had a mean of 19 teeth at enrollment. In all, 24% of subjects had 10 or fewer teeth, 15% had 11-20, and 22% had 28 or more teeth. Patients missing teeth tended to be older, heavier, and smokers. At 6 months of follow-up, those with 10 or fewer teeth had a significantly greater erythrocyte sedimentation rate, higher tender and swollen joint counts, and a higher Disease Activity Score-28 than did those with more than 10 teeth.
In a multivariate analysis adjusted for age, body mass index, and other potential confounders, patients with 10 or fewer teeth at baseline were 3.8 times as likely to have an insufficient treatment response as those with at least 28 teeth. The only other significant predictor of poor therapeutic response was smoking, which was associated with a 1.7-fold increased likelihood, noted Dr. Westhoff of the German Rheumatism Research Center in Berlin.
In a separate presentation, Dr. Axel Finckh of University Hospital, Geneva, reported that tooth loss was associated with swollen joints in a group of healthy individuals at increased risk of developing RA.
He presented data from an ongoing prospective observational study of 366 first-degree relatives of patients with RA. All were healthy at enrollment, at which time they had a mean of 28 teeth. Six percent had 20 or fewer teeth, 20% had 21-27, and 28% had a full complement of 32 teeth.
Subjects with one or more swollen joints on physical examination had an average of 26 teeth, compared with 29 teeth for those with no swollen joints. In a multivariate analysis, patients with less than 20 teeth were at 8.1-fold greater risk of having at least one swollen joint than those with 32 teeth. Individuals with 20-28 teeth were at 4.1-fold increased likelihood, while those with 28-31 teeth were at 3.6-fold increased risk.
Moreover, participants with less than 20 teeth had an adjusted 5.3-fold increased likelihood of having morning stiffness lasting more than 1 hour for at least 6 weeks than subjects with 32 teeth.
This study was sponsored by the Swiss League Against Rheumatism. Neither Dr. Finckh nor Dr. Westhoff reported having any financial conflicts.