Tooth Loss Severity Associated With Increased Disease Activity and Inflammatory Markers in RA

A link between tooth loss and rheumatoid arthritis (RA) disease activity scores and inflammation markers is investigated.

Tooth loss severity is associated with higher rheumatoid arthritis (RA) disease activity scores and inflammation marker levels in early and established disease, according to study findings published in Arthritis Care & Research.

Investigators enrolled patients with early RA from the Course And Prognosis of Early Arthritis (CAPEA) cohort study to assess the effect of the number of teeth at 0, 3, 6, 12, 18, and 24 months regarding disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) and ESR and C reactive protein (CRP) level.

A total of 1124 participants were included; their mean age was 56 years, 65% were women, and the mean disease duration was 13 ± 7 weeks. Complete 2-year follow-up data were available for 679 patients, and RA diagnosis was confirmed in 91% of participants. At baseline in the entire cohort, 24% of participants had all 28 teeth present, 40% had 20 to 27 teeth, 28% had 1 to 19 teeth, and 8% were edentulous.

Patients with greater tooth loss were older, more frequently men, and smokers, more often seropositive, and had higher DAS28-ESR and ESR and CRP values at baseline.

The number of teeth had a statistically significant effect on DAS28-ESR at every study visit during follow-up. The mean (SD) DAS28-ESR score for those with no teeth was 5.5 (1.2) compared with 4.5 (1.3) in those with all 28 teeth.

A significant association also was observed between number of teeth and ESR at every visit, except for the 18-month visit, and with CRP at baseline. The mean (SD) ESR was 42 (28) mm for those with no teeth vs 24 (21) mm for those with all 28 teeth. The mean (SD) CRP level was 25 (30) mg/L for those with no teeth vs 15 (33) mg/L for those with all 28 teeth.

Tooth loss was significantly associated with a higher percentage of glucocorticoid use at all visits.

The study also included 7179 participants from the German National Database with established RA; their mean age was 62 years, 74% were women, and the mean disease duration was 13 years. The study authors found that disease activity score and inflammatory markers were linearly associated with tooth loss severity after adjustment for age, sex, disease duration, rheumatoid factor, smoking, and education level.

The researchers noted that use of patient-reported number of teeth as an indicator for periodontitis as well as the fact that periodontal and tooth status were not assessed by a dentist are limitations to their findings. Also, the CAPEA data were obtained 10 years previously and treatment options have since improved.

“The patient-reported tooth count may be a helpful tool to consider periodontitis when evaluating RA disease activity and raised inflammatory markers,” stated the investigators. “Longitudinal data suggest that periodontitis/tooth loss does not hamper response to therapy as reduction of disease activity and tapering of glucocorticoids was successful regardless of the number of teeth.”

Disclosure: CAPEA was funded by an unconditional grant from Pfizer. Please see the original reference for a full list of funding information.


Albrecht K, de Pablo P, Eidner T, et al. Association between RA disease activity and periodontitis defined by tooth loss: longitudinal and cross-sectional data from two observational studies. Arthritis Care Res (Hoboken). Published online September 30, 2021. doi:10.1002/acr.24799