title: Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis.
abstract: BACKGROUND
  This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis.
  
  
  METHODS
  Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored.
  
  
  RESULTS
  Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001).
  
  
  CONCLUSIONS
  Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Coburn
authors.forename: Harlan R
authors.initials: HR
authors.lastname: Sayles
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Payne
authors.forename: Robert S
authors.initials: RS
authors.lastname: Redman
authors.forename: Jeffery C
authors.initials: JC
authors.lastname: Markt
authors.forename: Mark W
authors.initials: MW
authors.lastname: Beatty
authors.forename: Garth R
authors.initials: GR
authors.lastname: Griffiths
authors.forename: David J
authors.initials: DJ
authors.lastname: McGowan
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016301:Alveolar Bone Loss / Q000175:diagnosis; D001172:Arthritis, Rheumatoid / Q000150:complications*; D004522:Educational Status; D005260:Female; D005884:Gingival Hemorrhage / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications*; D010514:Periodontal Pocket / Q000175:diagnosis; D010518:Periodontitis / Q000175:diagnosis*; D010808:Physical Examination; D012015:Reference Standards; D015203:Reproducibility of Results; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012907:Smoking; D014086:Tooth Mobility / Q000175:diagnosis; D055815:Young Adult
keywords: Arthritis, rheumatoid; osteoarthritis; periodontitis; rheumatoid factor; self report; sensitivity and specificity