title: Oral status in patients with early rheumatoid arthritis: a prospective, case-control study.
abstract: OBJECTIVE
  Patients with RA suffer from a higher risk of periodontal attachment loss and increased oral inflammation. We hypothesize that there are pathogenetic and immunological interactions between these diseases that go beyond impaired manual dexterity accompanying advanced RA. The primary objective of the present study was to determine whether a loss of alveolar bone can be detected in RA patients during the early course of the disease.
  
  
  METHODS
  In this cross-sectional, epidemiological case-control study, 22 patients with early RA (ERA) were compared with 22 matched healthy controls. Oral and periodontal status, clinical activity, and socio-demographic parameters were determined. Oral microbiota were analysed using real-time quantitative PCR specific for leading oral pathogens.
  
  
  RESULTS
  More advanced forms of periodontitis were found in ERA patients compared with controls. ERA patients had a greater number of missing teeth [ERA 5.7 (s.d. 5.0), controls 1.9 (s.d. 1.0), P = 0.002], deeper periodontal pockets [clinical attachment level: ERA 3.4 (s.d. 0.5 mm), controls 2.7 (s.d. 0.3 mm), P < 0.000], and greater bleeding on probing [ERA 18.6% (s.d. 9.0%), controls 10.5% (s.d. 5.1%), P = 0.001] despite comparable oral hygiene. Tannerella forsythia (6.77-fold, P = 0.033) subgingivally and Streptococcus anginosus (3.56-fold, P = 0.028) supragingivally were the characteristic pathogens in ERA.
  
  
  CONCLUSIONS
  Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore we propose that the consulting rheumatologists inform the patients that they have a higher risk of periodontal disease. It would be beneficial if these patients were referred directly for intensive dental care.
authors.affiliation: Department of Conservative Dentistry, School of Dental Medicine, Im Neuenheimer Feld 400, 69117 Heidelberg, Germany. Diana.Wolff@med.uni-heidelberg.de.
authors.forename: Björn
authors.initials: B
authors.lastname: Wolff
authors.forename: Timo
authors.initials: T
authors.lastname: Berger
authors.forename: Cornelia
authors.initials: C
authors.lastname: Frese
authors.forename: Regina
authors.initials: R
authors.lastname: Max
authors.forename: Norbert
authors.initials: N
authors.lastname: Blank
authors.forename: Hanns-Martin
authors.initials: HM
authors.lastname: Lorenz
authors.forename: Diana
authors.initials: D
authors.lastname: Wolff
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000453:epidemiology*; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D010510:Periodontal Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: case–control studies; oral hygiene; periodontal attachment loss; periodontal index; plaque index; rheumatoid arthritis