Sains Malaysiana 48(3)(2019): 645–652

http://dx.doi.org/10.17576/jsm-2019-4803-18

Impact of Rheumatoid Arthritis Functional Status on Oral and Periodontal Health in a Multi-Ethnic Population

(Kesan Kefungsian Status Artritis Reumatoid ke atas Kesihatan Mulut dan Periodon Penduduk Berbilang Kaum)

NIK-MADIHAH NIK-AZIS^1*, FAZALINA MOHD FADZILAH², MOHD SHAHRIR MOHAMED SAID², BADIAH BAHARIN¹ & NURULHUDA MOHD¹

¹Periodontology Department, Faculty of Dentistry, Universiti Kebangsaaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

²Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000 Kuala Lumpur, Federal Territory, Malaysia

Received: 19 April 2018/Accepted: 4 January 2019

ABSTRACT

Periodontal disease (PD) has both been associated with the pathogenesis of Rheumatoid Arthritis (RA) and is also a comorbidity of RA. The aim of this study was to investigate the impact of the functional status of RA on oral and periodontal health in a multi-ethnic population. This is a hospital-based, multi-ethnic, observational study. Duration of illness, Disease Activity Score (DAS28), seropositivity and other rheumatological parameters were obtained from the records of RA patients attending the Rheumatology Clinic. Oral health examination was conducted on the subjects. Their functional status was assessed using the Health Assessment Questionnaire (HAQ) which includes categories in ‘dressing’, ‘rising’, ‘eating’, ‘walking’, ‘hygiene’, ‘reach’, ‘grip’ and ‘usual activities’. Data were analysed using ANOVA or Kruskal-Wallis test and Pearson’s Correlation or Spearman’s Rank Correlation Test. The 63 RA patients recruited had a mean disease duration of 10.7 ± 9.85 years with a mean of 19.9 teeth (± 7.18). The severity of PD worsens the longer the patients were suffering from RA (p=0.028). A high frequency (70%) of PD with 27% moderate and 27% severe, was observed. A significant association (p=0.035) was found between the ‘eating’ category of the HAQ and the average periodontal pocket depth. This study shows that there is a higher prevalence and severity of PD among RA patients in the selected population. The impact of functional status on periodontal health is mostly in the ‘eating’ category of the HAQ where patients reporting a disability in eating had higher average periodontal pocket depth.

Keywords: Function; health assessment questionnaire; periodontal disease; Rheumatoid Arthritis

ABSTRAK

Kajian terkini mengaitkan penyakit periodon (PD) sama ada sebagai punca penyakit Rheumatoid Arthritis (RA) atau sebagai kesan daripada penyakit RA. Kajian ini bertujuan untuk melihat kesan keupayaan dan fungsi dalam kalangan pesakit RA ke atas PD dalam populasi yang terdiri daripada pelbagai etnik. Kajian ini merupakan kajian keratan rentas berpusat di hospital. Jangka masa penyakit, Disease Activity Score (DAS28), status seropositif dan lain-lain maklumat perubatan diperoleh daripada rekod pesakit RA yang hadir ke klinik reumatologi. Pemeriksaan mulut turut dijalankan. Keupayaan fungsi pesakit dinilai menggunakan Soal Selidik Penilaian Kesihatan (HAQ) yang mempunyai kategori ‘memakai pakaian’, ‘bangun’, ‘makan’, ‘berjalan’, ‘kebersihan’, ‘jangkauan’, ‘genggaman’ dan ‘aktiviti harian’. Data dianalisis menggunakan ujian ANOVA atau Kruskal-Wallis serta Korelasi Pearson atau Korelasi Tingkat Spearman. 63 pesakit RA yang dikaji mempunyai purata penyakit 10.7 ± 9.85 tahun dan purata gigi 19.9 batang (± 7.18). Semakin lama pesakit menderita dengan penyakit RA, penyakit PD didapati menjadi lebih serius (p=0.028). Pesakit RA juga mempunyai PD dengan frekuensi yang tinggi (70%) dengan 27% adalah sederhana dan 27% pula serius. Terdapat kaitan yang signifikan (p=0.035) antara kategori ‘makan’ di dalam HAQ dan purata kedalaman poket periodon. Kajian ini menunjukkan bahawa frekuensi penyakit PD dalam kalangan pesakit RA adalah lebih tinggi dan lebih serius. Pesakit yang mempunyai keupayaan dan fungsi ‘makan’ yang terjejas juga didapati mempunyai kedalaman poket periodon lebih tinggi.

Kata kunci: Fungsi dan keupayaan; soal selidik penilaian kesihatan; penyakit periodontal; Rheumatoid Arthritis

REFERENCES

Abrão, A.L.P., Santana, C.M., Bezerra, A.C.B., de Amorim, R.F.B., da Silva, M.B., da Mota, L.M.H. & Falcão, D.P. 2016. What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. Revista Brasileira de Reumatologia 56(5): 441-450.

Ainamo, J. & Bay, I. 1975. Problems and proposals for recording gingivitis and plaque. International Dental Journal 25(4): 229-235.

Aletaha, D., Neogi, T., Silman, A.J., Funovits, J., Felson, D.T., Bingham, C.O., Birnbaum, N.S., Burmester, G.R., Bykerk, V.P., Cohen, M.D., Combe, B., Costenbader, K.H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J.M.W., Hobbs, K., Huizinga, T.W.J., Kavanaugh, A., Kay, J., Kvien, T.K., Laing, T., Mease, P., Ménard, H.A., Moreland, L.W., Naden, R.L., Pincus, T., Smolen, J.S., Stanislawska-Biernat, E., Symmons, D., Tak, P.P., Upchurch, K.S., Vencovský, J., Wolfe, F. & Hawker, G. 2010. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League against rheumatism collaborative initiative. Arthritis & Rheumatology 62(9): 2569-2581.

Araujo, V.M.A., Melo, I.M. & Lima, V. 2015. Relationship between periodontitis and rheumatoid arthritis: Review of the literature. Mediators of Inflammation 2015: 259074.

Bello-Gualtero, J.M., Lafaurie, G.I., Hoyos, L.X., Castillo, D.M., De-Avila, J., Munevar, J.C., Unriza, S., Londoño, J., Valle- Oñate, R. & Romero-Sanchez, C. 2015. Periodontal disease in individuals with a genetic risk of developing arthritis or with early rheumatoid arthritis: A cross-sectional study. Journal of Periodontal 87(4): 346-356.

Bowes, J. & Barton, A. 2008. Recent advances in the genetics of RA susceptibility. Rheumatology (Oxford) 47(4): 399-402.

Bruce, B. & Fries, J.F. 2003. The Stanford health assessment questionnaire: Dimensions and practical applications. Health and Quality of Life Outcomes 1: 20.

Chen, H.H., Huang, N., Chen, Y.M., Chen, T.J., Chou, P., Lee, Y.L., Chou, Y.J., Lan, J.L., Lai, K.L., Lin, C.H. & Chen, D.Y. 2013. Association between a history of periodontitis and the risk of rheumatoid arthritis: A nationwide, population-based, case–control study. Annals of Rheumatic Diseases 72(7): 1206-1211.

Choi, I.A., Kim, J., Kim, Y.M., Lee, J.Y., Kim, K.H., Lee, E.Y., Lee, E.B., Lee, Y. & Song, Y.W. 2016. Periodontitis is associated with rheumatoid arthritis: A study with longstanding rheumatoid arthritis patients in Korea. The Korean Journal of Internal Medicine 31(5): 977-986.

Dissick, A., Redman, R.S., Jones, M., Rangan, B.V., Reimold, A., Griffiths, G.R., Mikuls, T.R., Amdur, R.L., Richards, J.S. & Kerr, G.S. 2010. Association of periodontitis with rheumatoid arthritis: A pilot study. Journal of Periodontology 81(2): 223-230.

Edelman, J. & Russell, A.S. 1983. A comparison of patients with seropositive and seronegative rheumatoid arthritis. Rheumatology International 3: 47-48.

Eke, P.I., Page, R.C., Wei, L., Thornton-Evans, G. & Genco, R.J. 2012. Update of the case definitions for population-based surveillance of periodontitis. Journal of Periodontology 83(12): 1449-1454.

Eriksson, K., Nise, L., Kats, A., Luttropp, E. & Catrina, A.I. 2016. Prevalence of periodontitis in patients with established rheumatoid arthritis: A Swedish population based case-control study. PloS ONE 11(5): e0155956.

Feldman, R.O.Y.S., Szeto, B. & Uncev, H.H.C. 1983. Non-steroidal anti-inflammatory drugs in the reduction of human alveolar bone loss. Journal of Clinical Periodontology 10: 131-136.

Garib, B.T. & Qaradaxi, S.S. 2011. Temporomandibular joint problems and periodontal condition in rheumatoid arthritis patients in relation to their rheumatologic status. Journal of Oral and Maxillofacial Surgery 69(12): 2971-2978.

Gonzalez, S.M., Payne, J.B., Yu, F., Thiele, G.M., Erickson, A.R., Johnson, P.G., Schmid, M.J., Cannon, G.W., Kerr, G.S., Reimold, A.M., Sokolove, J., Robinson, W.H. & Mikuls, T.R. 2014. Alveolar bone loss is associated with circulating anti-citrullinated protein antibody (ACPA) in patients with rheumatoid arthritis. Journal of Periodontology 86(2): 222- 231.

Joseph, R., Rajappan, S., Nath, S.G. & Paul, B.J. 2013. Association between chronic periodontitis and rheumatoid arthritis: A hospital-based case-control study. Rheumatology International 33(1): 103-109.

Kaur, S., White, S. & Bartold, P.M. 2013. Periodontal disease and rheumatoid arthritis: A systematic review. Journal of Dental Research 92(5): 399-408.

Khantisopon, N., Louthrenoo, W., Kasitanon, N., Sivasomboon, C., Wangkaew, S., Sang-In, S., Jotikasthira, N. & Bandhaya, P. 2014. Periodontal disease in Thai patients with rheumatoid arthritis. International Journal of Rheumatic Diseases 17(5): 511-518.

Klein, H. & Palmer, C. 1938. Studies on dental caries. Public Health Reports 53(38): 1685-1732.

Kong, K., Yeap, S., Chow, S. & Phipps, M.E. 2002. HLA-DRB1 genes and susceptibility to rheumatoid arthritis in three ethnic groups from Malaysia. Autoimmunity 35(4): 235-239.

Konig, M.F., Abusleme, L., Reinholdt, J., Palmer, R.J., Teles, R.P., Sampson, K., Rosen, A., Nigrovic, P.A., Sokolove, J., Giles, J.T., Moutsopoulos, N.M. & Andrade, F. 2016. Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Science Translational Medicine 8(369): 1-13.

Leary, J.O., Drake, B. & Naylor, J.E. 1972. The plaque control record. Journal of Periodontology 43(1): 38.

McCann, K. 2007. Nutrition and rheumatoid arthritis. Explore (NY) 3(6): 616-618.

McHugh, J. 2017. Rheumatoid arthritis: New model linking periodontitis and RA. Nature Reviews Rheumatology 13(2): 66.

Meenan, R.F., Mason, J.H., Anderson, J.J., Guccione, A.A. & Kazis, L.E. 1992. AIMS2. The content and properties of a revised and expanded arthritis impact measurement scales health status questionnaire. Arthritis & Rheumatology 35(1): 1-10.

Mercado, F.B., Marshall, R.I., Klestov, A.C. & Bartold, P.M. 2001. Arthritis and periodontitis. Journal of Periodontology 72: 779-787.

Mikuls, T.R., Payne, J.B., Yu, F., Thiele, G.M., Reynolds, R.J., Cannon, G.W., Markt, J., McGowan, D., Kerr, G.S. & Redman, R.S. 2014. Periodontitis and Porphyromonas gingivalis in patients with rheumatoid arthritis. Arthritis & Rheumatology 66(5): 1090-1100.

Mizukami, Y., Matsui, T., Tobma, S. & Masuko, K. 2017. Distinct patterns of dietary intake in different functional classes of patients with rheumatoid arthritis. Topics in Clinical Nutrition 32(2): 141-151.

Pischon, N., Pischon, T., Kroger, J., Gulmez, E., Kleber, B.M., Bernimoulin, J.P., Landau, H., Brinkmann, P.G., Schlattmann, P., Zernicke, J., Buttgereit, F. & Detert, J. 2008. Association among rheumatoid arthritis, oral hygiene, and periodontitis. Journal of Periodontology 79(6): 979-986.

Potikuri, D., Dannana, K.C., Kanchinadam, S., Agrawal, S., Kancharla, A., Rajasekhar, L., Pothuraju, S. & Gumdal, N. 2012. Periodontal disease is significantly higher in non-smoking treatment-naive rheumatoid arthritis patients: Results from a case-control study. Annals of Rheumatic Diseases 71: 1541-1544.

Raindi, D. 2016. Nutrition and periodontal disease. Dental Update 43(1): 66-68, 71-72.

Scher, J.U., Ubeda, C., Equinda, M., Khanin, R., Buischi, Y., Viale, A., Lipuma, L., Attur, M., Pillinger, M.H., Weissmann, G., Littman, D.R., Pamer, E.G., Bretz, W.A. & Abramson, S.B. 2012. Periodontal disease and the oral microbiota in new-onset rheumatoid arthritis. Arthritis & Rheumatology 64(10): 3083-3094.

Schmickler, J., Rupprecht, A., Patschan, S., Patschan, D. & Gerhard, A. 2016. Cross-sectional evaluation of periodontal status, microbiological and rheumatoid parameters in a large cohort of patients with rheumatoid arthritis. Journal of Periodontal 88(4): 368-379.

Shariq, N., Zafar, M.S., Khurshid, Z., Sana, Z. & Almas, K. 2016. The role of nutrition in periodontal health: An update. Nutrients 8(9): 530.

Susanto, H., Nesse, W., Kertia, N., Soeroso, J., Huijser van Reenen, Y., Hoedemaker, E., Agustina, D., Vissink, A., Abbas, F. & Dijkstra, P.U. 2013. Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. Journal of Periodontal 84(8): 1067-1074.

Takashiba, S., Ohyama, H., Oyaizu, K., Kogoe-Kato, N. & Murayama, Y. 1999. HLA genetics for diagnosis of susceptibility to early-onset periodontitis. Journal of Periodontal Research 34(7): 374-378.

Tonetti, M.S., Jepsen, S. & Jin, L. 2017. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. Journal of Clinical Periodontal 44(5): 456-462.

Young, A., Dixey, J., Cox, N., Davies, P., Devlin, J., Emery, P., Gallivan, S., Gough, A., James, D., Prouse, P., Williams, P. & Winfield, J. 2000. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS). Rheumatology (Oxford) 39: 603-611.

Yuki, M., Toshihiro, M., Shigeto, T. & Kayo, M. 2017. Distinct patterns of dietary intake in different functional classes of patients with Rheumatoid Arthritis. Topics in Clinical Nutrition 32(2): 141-151.

*Corresponding author; email: nikmadihah@ukm.edu.my