Periodontal Status in Relation to Severity of Rheumatoid Arthritis Among Patients Attending the Kenyatta National Hospital

Abstract

Background: Periodontal disease prevalence is high globally as well as in Kenya affecting about 80% of the population. Rheumatoid arthritis prevalence in Kenya was estimated to be about 4.3 million people in 2018. Both periodontal disease and rheumatoid arthritis being multifactorial complex diseases, have similar aetiopathogenetic mechanisms of chronic inflammation and bone destruction. Periodontal and rheumatoid diseases lead to significant morbidity, with periodontal disease (PD) eventually causing tooth loss and loss of masticatory function, while RA leads to loss of joint function and mobility. Together, development of both diseases brings considerable consequences for public health and for the quality of life of affected individuals. Study Objective: To investigate the status of periodontal disease and relate it to the severity of rheumatoid arthritis in patients attending the Rheumatoid Outpatient Clinic (ROPC) at Kenyatta National Hospital (KNH). Setting: Rheumatoid Outpatient Clinic at the Kenyatta National Hospital. Study design: A hospital-based descriptive cross-sectional study. Study participants: The study participants were patients above 18 years of age who were already diagnosed with rheumatoid arthritis and visiting the Rheumatology Outpatient Clinic (ROPC) Materials and methods: Eighty-six (86) participants who fitted the inclusion criteria were recruited into the study by using non probability convenient sampling method. Rheumatoid arthritis (RA) disease activity was determined using Clinical Disease Activity Index (CDAI). Oral hygiene was assessed using Turesky et al modified Quigley Hein Plaque Index (TQHPI) while gingival status determination was carried out using (Loe and Silness,1963). Periodontal examination was based on the Basic Periodontal Examination (BPE). Bio-data and social demographic information was obtained through a questionnaire. Severity of rheumatoid arthritis was assessed using Clinical Disease Activity Index (CDAI) by simple summation of the number of tender joints and swollen joints from the 28-joint

count pattern, the patient’s global assessment of disease activity and the provider/physician global assessment of disease activity. Data Management and Analysis: Data collected were coded and entered into a computer. Cleaning of the data was done thereafter it was subjected to analysis using SPSS Version 23.0 for Windows (SPSS Inc Illinois, Chicago, USA). Obtained results are presented in the form of text, frequency diagrams, graphs tables, pie charts among others. Results: A total of 86 cases was included in the study. The age ranged from 18 – 82 with a mean age of 52.17 (+16.19 SD), a median of 55 and a mode of 45 years. Majority, 60 (69.8%) had moderate to severe gingival inflammation while 26 (30.2%) had mild gingival inflammation Also, according to CDAI, the majority of patients had moderate to severe rheumatoid arthritis disease activity. There was no association found between the status of periodontal disease and the severity of rheumatoid arthritis. (t 0.70 p 0.49) Conclusion: The study did not find any association between periodontal disease and the levels of rheumatoid arthritis disease activity in patients already diagnosed with rheumatoid arthritis. Recommendations Based on the findings of this study, the following was recommended. a. Known RA arthritis patients need periodontal examination and treatment where necessary. b. To determine the timing of these two diseases and effect of periodontal disease on severity of rheumatoid arthritis, longitudinal studies and more research is required.