Relationship between juvenile idiopathic arthritis and periodontal diseases
PDF

Keywords

Juvenile idiopathic arthritis
Periodontal diseases
Gingival index
Plaque index

How to Cite

Abbass, S., Shihab, S., Salman, M., & Radhi, N. (2022). Relationship between juvenile idiopathic arthritis and periodontal diseases. Rheumatology (Bulgaria), 30(1), 16-26. https://doi.org/10.35465/30.1.2022.pp16-26

Abstract

Background: Juvenile idiopathic arthritis (JIA) is an arthritis of unknown etiology that begins before the 16th birthday and persists for at least six weeks with other known conditions excluded. In JIA, there is a destructive inflammatory process in the border between bone and connective tissue of the joint similar to the inflammatory process of the supporting tissue around the tooth in periodontitis.

Objective: To emphasize the role of a pedo-dentist in the multidisciplinary management of JIA (to treat this detrimental disease before it becomes irreversible).

Patients and Methods: A case-control study was conducted among JIA patients at Baghdad Teaching Hospital, Rheumatology Unit and private rheumatology clinic during the period September 2020 to May 2021. Twenty Iraqi patients diagnosed with JIA by rheumatologist (after fulfilling International League of Associations for Rheumatology (ILAR) criteria), compared with 20 healthy control individuals matched age. All patients were sent to specialized pediatric dental clinic in Baghdad where dental examination was applied. The examinations were conducted by two certified specialist pedo-dentist to indices Dental findings (dmf-s/DMF-S), Gingival inflammation (GI), Plaque index (PI). The surfaces of Ramfjord teeth were examined with diagnostic instruments (mirror and periodontal probe) and scored for all indices.

Results: According to joint numbers involved, the polyarticular manner was the most common in 40% of patients, followed by oligoarticular in 35% of patients, and systematic manner in 20% of patients. In addition, one case presented with enthesitis related arthritis. The mean of gingival index (GI) in patients’ group (0.88±0.623) was higher than that of control group (0.61±0.53), without any significant difference (p=0.0545). However, the plaque index (PI) results showed high statistically significant difference (p=0.0162), similarly, the dmfs demonstrated a high significant difference (p=0.026) between patient and control groups. The DMFs was statistically significant (p=0.015), CRP level in relation to the indices, all indices have a significant high level association level (≥5mg/L) over normal level of CRP (<5 mg/L), effect of Prednisolone was statistically significant for GI (p=0.0245), and dmfs (p=0.0015). However, it was not significantly different in the value of PI (p=0.098), and DMFs (p=0.0627). In our study DMARDs (MTX) had a direct effect on GI and PI with a statistically significant difference (p=0.0164), and (p=0.017), respectively. Finally, the role of MTX on dmfs and DMFs was not significant.

Conclusions: The indices used in this study to evaluate oral health in JIA children were GI has no significant difference compared to healthy children; PI was significantly higher compared to healthy children; the dmfs/DMFS both showed significantly higher compared to healthy children. The high CRP level has a significant association with GI, PI and dmfs, but no significant association with DMFs. Regarding the JIA treatment, Prednisolone has significantly modified all indices (in particular GI and DMFs), NSAIDs has significantly modified PI only, DMARDs (MTX) had direct effect on GI and PI, but no role on dmfs and no significant effect on DMFs.

https://doi.org/10.35465/30.1.2022.pp16-26
PDF

References

  1. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.
  2. Gowdie P, Tse S. Chapter 7 - Juvenile Idiopathic Arthritis. In: The Heart in Rheumatic, Autoimmune and Inflammatory Diseases. 2017. p. 167–87.
  3. Cassidy JT, Petty RE, Laxer RM, Lindsley CB. Textbook of pediatric rheumatology. Churchill Livingstone New York; 2011. p. 211-35.
  4. Fujikawa S, Okuni M. Clinical analysis of 570 cases with juvenile rheumatoid arthritis: Results of a nationwide retrospective survey in Japan. Pediatr Int. 1997;39(2):245–9.
  5. Silverman E, Mouy R, Spiegel L, et al. Leflunomide or Methotrexate for Juvenile Rheumatoid Arthritis. N Engl J Med. 2005 Apr 21;352(16):1655–66.
  6. Reinfjell T, Diseth TH, Veenstra M, Vikan A. Measuring health-related quality of life in young adolescents: Reliability and validity in the Norwegian version of the Pediatric Quality of Life InventoryTM 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes. 2006 Sep 14;4(1):1–9.
  7. Szer, Ilona S and Szer, Ilona and Kimura, Yukiko and Malleson P. Arthritis in children and adolescents: juvenile idiopathic arthritis. Oxford university press; 2006.
  8. Miranda LA, Fischer RG, Sztajnbok FR, et al. Periodontal conditions in patients with juvenile idiopathic arthritis. J Clin Periodontol. 2003 Nov;30(11):969–74.
  9. Miranda LA, Fischer RG, Sztajnbok FR, et al. Changes in Periodontal and Rheumatological Conditions After 2 Years in Patients With Juvenile Idiopathic Arthritis The impact of juvenile systemic lupus erythematosus and Juvenile rheumatoid arthritis (JIA) in the periodontal conditions View project. Artic J Periodontol. 2006 Oct;77(10):1695–700.
  10. Havemose-Poulsen A, Westergaard J, Stoltze K, et al. Periodontal and Hematological Characteristics Associated With Aggressive Periodontitis, Juvenile Idiopathic Arthritis, and Rheumatoid Arthritis. J Periodontol. 2006 Feb;77(2):280–8.
  11. Reichert S, Machulla H, Fuchs C, et al. Is there a relationship between juvenile idiopathic arthritis and periodontitis? J Clin Periodontol. 2006 May;33(5):317–23.
  12. Storhaug K. Dental health problems in juvenile chronic arthritis. Eular Bull. 1977;3:88–92.
  13. Siamopoulou A, Mavridis A, Vasakos S, et al. Sialochemistry in juvenile chronic arthritis. Br J Rheumatol. 1989;28:383–5.
  14. Malmstrom M, Boris Calonius P. Teeth loss and the Inflammation of teeth-supporting tissues in rheumatoid disease: a roentgenologic and histologic study. Scand J Rheumatol. 1975;4(2):49–55.
  15. Walton A, Welbury R, Thomason J, et al. Oral health and juvenile idiopathic arthritis: a review. Rheumatology. 2000;39(5):550–5.
  16. Tanchyk A. Dental considerations for the patient with juvenile rheumatoid arthritis. Gen Dent. 1991;39(5):330–2.
  17. Turesky S, Gilmore ND, Glickman I, et al. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol. 1970;41(1):41–3.
  18. Shea B, Swinden MV, Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. The Cochrane Database of Systematic Reviews. 2013 May(5):CD000951.
  19. Dchimmer B. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. Goodman Gilman’s Pharmacol basis Ther. 27014BC.
  20. Roberts GJ, Roberts IF. Dental disease in chronically sick children. ASDC J Dent Child. 1981 Sep;48(5):346–51.
  21. Shallan Z, Al-Rawi NA. Oral Health Status among Group of Patients with Juvenile Idiopathic Arthritis According to Duration of Illness and Age Group in Iraq. J Baghdad Coll Dent. 2016;28(4):158–67.
  22. Curtin C, Bandini LG, Perrin EC, et al. Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: A chart review. Vol. 5, BMC Pediatrics. 2005.
  23. Abdwani R, Abdalla E, Al Abrawi S, et al. Epidemiology of juvenile idiopathic arthritis in Oman. Pediatr Rheumatol. 2015 Aug 1;13(1).
  24. Naser, Wafaa Eskander, Others. Assessment of the quality of life of Iraqi children with juvenile idiopathic arthritis: A single-center study. Med J Babylon. 2019;16(1):65.
  25. Muhsin HY, Al-Massawei M, Ad’hiah AH, et al. Assessment of IL-2 Serum Level in Juvenile Idiopathic Arthritis and Adult Onset Rheumatoid Arthritis in Samples of Iraqi Patients. Vol. 3, Current Research in Microbiology and Biotechnology. 2015.
  26. Minden K, Niewerth M, Listing J, et al. Burden and cost of illness in patients with juvenile idiopathic arthritis. Ann Rheum Dis. 2004;63(7):836–42.
  27. Sahin Y, Sahin S, Barut K, et al. Serological screening for coeliac disease in patients with juvenile idiopathic arthritis. Arab J Gastroenterol. 2019;20(2):95–8.
  28. Lepore L, Martelossi S, Pennesi M, et al. Prevalence of celiac disease in patients with juvenile chronic arthritis. J Pediatr. 1996;129(2):311–3.
  29. Grevich S, Lee P, Leroux B, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol. 2019 Dec 16;17(1).
  30. Al-bassam WW, Ad’hiah AH, Mayouf KZ. Biomarker Significance of Interleukin-18 in Juvenile Idiopathic Arthritis. Iraqi J Sci. 2020;61(12):3200–7.
  31. Khalaf ZS, Al-Rawi NA, Jassim NA. Temporomandibular Joint Disorders among Patients with Juvenile Idiopathic Arthritis. IRAQI Postgrad Med J. 2017;16(1).
  32. Skeie MS, Gil EG, Cetrelli L, et al. Oral health in children and adolescents with juvenile idiopathic arthritis - A systematic review and meta-analysis. BMC Oral Health. 2019;19(1).
  33. Merle CL, Hoffmann R, Schmickler J, et al. Comprehensive Assessment of Orofacial Health and Disease Related Parameters in Adolescents with Juvenile Idiopathic Arthritis—A Cross-Sectional Study. J Clin Med. 2020;9(2):513.
  34. Thomason JM, Seymour RA, Rice N. The prevalence and severity of cyclosporin and nifedipine‐induced gingival overgrowth. J Clin Periodontol. 1993;20(1):37–40.
  35. Welbury R, Thomason J, Fitzgerald J, et al. Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis. Rheumatology. 2003;42(12):1445–51.
  36. Olson L, Eckerdal O, Hallonsten A, et al. Micrognathia, temporomandibular joint changes and dental occlusion in juvenile rheumatoid arthritis of adolescents and adults. Eur J Oral Sci. 1981;89(4):329–38.
  37. Olson L, Eckerdal O, Hallonsten A, et al. Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study. Swed Dent J. 1991;15(2):71–83.
  38. Shallan Z, Al-Rawi NA. Oral Health Status among Group of Patients with Juvenile Idiopathic Arthritis According to Duration of Illness and Age Group in Iraq. J Baghdad Coll Dent. 2016;28(4):158–67.
  39. Grevich S, Lee P, Leroux B, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol. 2019;17(1).
  40. Al-Haddad K, Al-Hebshi N, Al-Ak’hali M. Oral health status and treatment needs among school children in Sana’a City, Yemen. Wiley Online Libr. 2010;8(2):80–5.
  41. Manners P, Lesslie J, Speldewinde D, et al. Classification of juvenile idiopathic arthritis: should family history be included in the criteria? jrheum.org.
  42. Grosfeld O. he orthodontist in the team-treatment for children with rheumatoid arthritis. Eur J Orthod. 1989;11(2):120–4.
  43. Kadkhoda Z, Amirzargar A, Esmaili Z, et al. Effect of TNF-α Blockade in Gingival Crevicular Fluid on Periodontal Condition of Patients with Rheumatoid Arthritis. IranJImmunol. 2016;13(3).
  44. Lovell DJ, Giannini EH, Reiff A, Cawkwell GD, Silverman ED, Nocton JJ, et al. Etanercept in Children with Polyarticular Juvenile Rheumatoid Arthritis. N Engl J Med. 2000 Mar 16;342(11):763–9.
  45. Reichert S, Machulla H, … CF-J of clinical, 2006 undefined. Is there a relationship between juvenile idiopathic arthritis and periodontitis? Wiley Online Libr [Internet]. 2006 May [cited 2021 Jul 7];33(5):317–23.
  46. Paquette D, 2000 RW-P, 2000 undefined. Modulation of host inflammatory mediators as a treatment strategy for periodontal diseases. europepmc.org [Internet]. [cited 2021 Jul 7]; Available from: https://europepmc.org/article/med/11276870
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.