Aims: Studies have investigated the interrelationship between periodontitis (PD) and rheumatoid arthritis (RA). However, obesity, a risk factor common between both conditions requires further investigation. Therefore, the objective of this study was to pool evidence on whether concurrent RA and PD (RAPD) are associated with high Body Mass Index (BMI) compared to non-RAPD individuals. Methods: Systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with the protocol registered with the International Prospective Register of Systematic Reviews. Embase, Medline, Web of Science and the Cochrane Library were accessed for relevant literature. The Newcastle-Ottawa scale was used to assess risk of bias among each study. Meta-analysis was performed using Revman statistical software. The effect size was measured using mean difference with 95% confidence intervals and a p-value of 0.05. Results: The search identified 770 articles. Following screening of title with abstracts and full text assessment, nine studies, involving 86,137 participants were included. Seven studies reported low to moderate risk of bias. In meta-analysis BMI was higher in people with RAPD than non-RAPD (MD = 0.56; Z = 2.06; p = 0.04). Conclusion: The correlation between high BMI and RAPD underscores a potential interplay between periodontal health and inflammatory diseases like obesity and RA. Thus, observational studies are warranted.
BakerJFSauerBCCannonGW, et al. (2016) Changes in body mass related to the initiation of disease‐modifying therapies in rheumatoid arthritis. Arthritis & Rheumatology68: 1818–1827. https://doi.org/10.1002/art.39647
BastardJ-PJardelCBruckertE, et al. (2000) Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of Obese women after weight loss. The Journal of Clinical Endocrinology & Metabolism85: 3338–3342. https://doi.org/10.1210/jcem.85.9.6839
4.
BendreMJaiswalDAgrawalD (2020) Evaluation of the relationship between obesity and severity of periodontal diseases in rural population: a Study protocol. European Journal of Molecular & Clinical Medicine7: 2034–2037.
5.
BlackRJGoodmanSMRuedigerC, et al. (2017) A survey of glucocorticoid adverse effects and benefits in rheumatic diseases: the patient perspective. Journal of Clinical Rheumatology23: 416–420. https://doi.org/10.1097/RHU.0000000000000585
6.
BrightRProudmanSMRosensteinEDBartoldPM (2015) Is there a link between carbamylation and citrullination in periodontal disease and rheumatoid arthritis?Medical Hypotheses84: 570–576. Available at: https://doi.org/10.1016/j.mehy.2015.03.006
7.
CatonJGArmitageGBerglundhT, et al. (2018) A new classification scheme for periodontal and peri‐implant diseases and conditions–introduction and key changes from the 1999 classification. Journal of Clinical Periodontology89: S1–S8. https://doi.org/10.1111/jcpe.12935
8.
CoburnBWSaylesHRPayneJB, et al. (2015) Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis. Journal of Periodontology86: 16–26. https://doi.org/10.1902/jop.2014.140339
9.
DemmerRTMolitorJAJacobsJ, et al. (2011) Periodontal disease, tooth loss and incident rheumatoid arthritis: results from the first national health and nutrition examination survey and its epidemiological follow-up study. Journal of Clinical Periodontology38: 998–1006. https://doi.org/10.1111/j.1600-051X.2011.01776.x
10.
DownesMJBrennanMLWilliamsHC, et al. (2016) Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open6: e011458. https://doi.org/10.1136/bmjopen-2016-011458.
11.
EkePIPageRCWeiL, et al. (2012) Update of the case definitions for population‐based surveillance of periodontitis. Journal of Periodontology83: 1449–1454. https://doi.org/10.1902/jop.2012.110664
12.
EkuniDMizutaniSKojimaA, et al. (2014) Relationship between increases in BMI and changes in periodontal status: a prospective cohort study. Journal of Clinical Periodontology41: 772–778. https://doi.org/10.1111/jcpe.12273
13.
ErikssonKFeiGLundmarkA, et al. (2019) Periodontal health and oral microbiota in patients with rheumatoid arthritis. Journal of Clinical Medicine8: 630. https://doi.org/10.3390/jcm8050630
14.
FengXXuXShiY, et al. (2019) Body mass index and the risk of rheumatoid arthritis: an updated dose-response meta-analysis. BioMed Research International2019: 1–12. https://doi.org/10.1155/2019/3579081
GerlagDMNorrisJMTakPP (2016) Towards prevention of autoantibody-positive rheumatoid arthritis: from lifestyle modification to preventive treatment. Rheumatology55: 607–614. https://doi.org/10.1093/rheumatology/kev347
18.
KällbergHPadyukovLPlengeRM, et al. (2007) Gene-gene and gene-environment interactions involving HLA-DRB1, PTPN22, and smoking in two subsets of rheumatoid arthritis. The American Journal of Human Genetics80: 867–875.
19.
KarapetsaDConsensiACastagnoliG, et al. (2022) Periodontitis in Italian patients with established rheumatoid arthritis: a cross‐sectional study. Oral Diseases28: 1715–1722. https://doi.org/10.1111/odi.13842
20.
KuzmanovaVTodorovSKuzmanovA, et al. (2018) Association between obesity and periodontitis. Scripta Scientifica Vox Studentium2: 62.
21.
MalikVSHuFB (2022) The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nature Reviews Endocrinology18: 205–218. https://doi.org/10.1038/s41574-021-00627-6
22.
Martínez-GarcíaMHernández-LemusE (2021) Periodontal inflammation and systemic diseases: an overview. Frontiers in Physiology12: 709438.
23.
MoschouDKrikelisMGeorgakopoulosC, et al. (2023) Sarcopenia in Rheumatoid arthritis. A narrative review. Journal of Frailty, Sarcopenia and Falls8: 44–52. https://doi.org/10.22540/JFSF-08-044
24.
NaranjoASokkaTDescalzoMA, et al. (2008) Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Research and Therapy10: 1–10. https://doi.org/10.1186/ar2383
25.
OkunogbeANugentRSpencerG, et al. (2022) Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Global Health7: e009773. https://doi.org/10.1136/bmjgh-2022-009773
26.
PageRCEkePI (2007) Case definitions for use in population‐based surveillance of periodontitis. Journal of Periodontology78: 1387–1399. https://doi.org/10.1902/jop.2007.060264
27.
PageMJMoherDBossuytPM, et al. (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ372: 1–36. https://doi.org/10.1136/bmj.n160
28.
PischonNPischonTKrögerJ, et al. (2008) Association among rheumatoid arthritis, oral hygiene, and periodontitis. Journal of Periodontology79: 979–986. https://doi.org/10.1902/jop.2008.070501
29.
SczepanikFSCGrossiMLCasatiM, et al. (2020) Periodontitis is an inflammatory disease of oxidative stress: we should treat it that way. Periodontology 200084: 45–68. https://doi.org/10.1111/prd.12342
30.
SezerUErciyasKÜstünK, et al. (2013) Effect of chronic periodontitis on oxidative status in patients with rheumatoid arthritis. Journal of Periodontology84: 785–792. https://doi.org/10.1902/jop.2012.120179
SilvestreF-JSilvestre-RangilJBaganL, et al. (2016) Effect of nonsurgical periodontal treatment in patients with periodontitis and rheumatoid arthritis: a systematic review. Medicina Oral, Patología Oral y Cirugía Bucal21: e349–e354. https://doi.org/10.4317/medoral.20974Article.
33.
SöderlinMKPerssonGRRenvertS, et al. (2021) Cytokines in gingival crevicular fluid in elderly rheumatoid arthritis patients in a population‐based cross‐sectional study: RANTES was associated with periodontitis. Journal of Periodontal Research56: 907–916.
34.
SusantoHNesseWKertiaN, et al. (2013) Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. Journal of Periodontology84: 1067–1074. https://doi.org/10.1902/jop.2012.110321
35.
SymmonsDPBankheadCRHarrisonBJ, et al. (1997) Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis. Results from a primary care‐based incident case‐control study in Norfolk, England. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology40: 1955–1961. https://doi.org/10.1002/art.1780401106
36.
TokmakidisSPChristodoulosADMantzouranisNI (2007) Validity of self-reported anthropometric values used to assess body mass index and estimate obesity in Greek school children. Journal of Adolescent Health40: 305–310. https://doi.org/10.1016/j.jadohealth.2006.10.001
37.
Van ZantenAArendsSRoozendaalC, et al. (2017) Presence of anticitrullinated protein antibodies in a large population-based cohort from the Netherlands. Annals of the Rheumatic Diseases76: 1184–1190. https://doi.org/10.1136/annrheumdis-2016-209991
38.
World Health Organization (2000) Obesity: preventing and managing the global epidemic: report of a WHO consultation. WHO Technical Report Series, Vol. 894.
39.
ZhaoXLiuZShuD, et al. (2018) Association of periodontitis with rheumatoid arthritis and the effect of non-surgical periodontal treatment on disease activity in patients with rheumatoid arthritis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research24: 5802–5810. https://doi.org/10.12659/MSM.909117
40.
ZhouYSunM (2018) A meta-analysis of the relationship between body mass index and risk of rheumatoid arthritis. EXCLI Journal17: 1079–1089. https://doi.org/10.17179/excli2018-1763
