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Does Periodontitis Represent a Risk Factor for Rheumatoid Arthritis? A Systematic Review and Meta-Analysis

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Review

Does Periodontitis Represent a Risk Factor for Rheumatoid Arthritis? A Systematic Review and Meta-Analysis

Railson de Oliveira Ferreira et al. Ther Adv Musculoskelet Dis.

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.

Keywords: periodontitis; rheumatoid arthritis; systematic review.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of databases searched according to PRISMA guidelines. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis.
Figure 2.
Figure 2.
Forest plot of meta-analysis for three studies (I2 = 96%). The association between periodontitis and RA. CI, confidence interval; M-H, Mantel-Haenszel method; RA, rheumatoid arthritis.
Figure 3.
Figure 3.
Forest plot of meta-analysis for two studies (I2 = 69%). The association between periodontitis and RA. CI, confidence interval; M-H, Mantel-Haenszel method; RA, rheumatoid arthritis.

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