Bidirectional Relationship Between Periodontitis and Osteoarthritis in a Population-Based Cohort Study Over 15-years Follow-up - European Medical Journal

Bidirectional Relationship Between Periodontitis and Osteoarthritis in a Population-Based Cohort Study Over 15-years Follow-up

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Rheumatology Feature Image
Kevin Sheng-Kai Ma,1 *James Cheng-Chung Wei2

The authors did not disclose any conflicts of interest.

EMJ Rheumatol. ;8[1]:68-68. Abstract Review No. AR8.
Bidirectional relationship, cohort study, osteoarthritis (OA), periodontitis.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Osteoarthritis (OA) has been proposed to result from complement-mediated inflammatory cascades; on the other hand, periodontal disease (PD) has been shown to trigger systemic inflammation through
complement-mediated pathways.


In this population-based cohort study, the authors determined the relationship between OA and PD through 144,788 patients with PD and 144,788 propensity score-matched controls without previous history of PD. Cox proportional hazard regression was used to derive the hazard ratios (HRs) of OA. Survival analysis was used to estimate the time-dependent effect of PD on risk of OA. Age and sex were stratified in a subgroup analysis. A parallel case-control analysis was conducted to investigate whether the relationship between OA and PD was bidirectional through estimating the association between PD and history of OA.


Patients with PD were associated with higher risk of OA (HR: 1.15; 95% confidence interval [CI]: 1.12–1.17; p<0.001) and severe OA that required total knee replacement or total hip replacement (TKR/THR; HR: 1.12; 95% CI: 1.03–1.21; p<0.01) than controls; this association was time-dependent (log-rank test p<0.01). The effect of PD on OA was significant in both sexes and patients aged >30 years (p<0.001). Females (HR: 1.27; 95% CI: 1.13–1.42; p<0.001) and patients aged >51 years (HR: 1.21; 95% CI: 1.10–1.33; p<0.001) with PD were predisposed to severe OA that required TKR/THR. Also, patients with PD were associated with a history of OA (OR: 1.11; 95%
CI: 1.06–1.17; p<0.001).


In conclusion, these findings support a bidirectional relationship between OA and PD. Patients with PD had a higher risk of OA, including severe OA requiring TKR/THR; moreover, PD may develop following OA. Regular follow-ups for patients with either PD or OA are recommended based on the clinical relevance of this
real-world study.

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