title: Hand to Mouth: A Systematic Review and Meta-Analysis of the Association between Rheumatoid Arthritis and Periodontitis.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) and periodontitis are both chronic inflammatory diseases, which demonstrate similarities in terms of mechanism, histopathology, and demography. An association between these conditions has been demonstrated previously but has been called into question more recently.
  
  
  METHODS
  The published databases, such as MEDLINE, EMBASE, and PsycINFO, were searched using search terms related to RA and periodontitis. Articles were selected if they included data on the number of people with RA diagnosed with periodontitis (or periodontal disease parameters) compared to a control comparison group. Review articles, case reports, animal model studies, non-English language, and articles with unavailable abstracts were excluded. Data were extracted, critically appraised using the Downs and Black tool, and a random-effect Mantel-Haenszel meta-analysis was performed.
  
  
  RESULTS
  Twenty-one papers met the eligibility criteria and provided data for the meta-analysis; 17 studies (including a total of 153,492 participants) comparing RA to healthy controls and 4 (including a total of 1378 participants) comparing RA to osteoarthritis (OA). There was a significantly increased risk of periodontitis in people with RA compared to healthy controls (relative risk: 1.13; 95% CI: 1.04, 1.23; p = 0.006; N = 153,277) with a significantly raised mean probing depth, risk of bleeding on probing (BOP), and absolute value of clinical attachment loss in those with RA. When comparing RA and OA, there was no significant difference in the prevalence of periodontitis; however, the risk of BOP was greater in OA than RA.
  
  
  CONCLUSIONS
  A significant association between RA and periodontitis is supported by the results of our systematic review and meta-analysis of studies comparing RA to healthy controls. In our meta-analysis, however, this is not replicated when comparing RA to OA controls.
authors.affiliation: Musculoskeletal Research Group, Institute of Infection and Immunity, St George's University of London , London , UK.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Fuggle
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia , Norwich , UK.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: Department of Rheumatology, St George's University Hospitals NHS Foundation Trust , London , UK.
authors.forename: Arvind
authors.initials: A
authors.lastname: Kaul
authors.affiliation: Musculoskeletal Research Group, Institute of Infection and Immunity, St George's University of London, London, UK; Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sofat
keywords: inflammatory arthritis; meta-analysis; periodontal disease; periodontitis; rheumatoid arthritis