Association between periodontal disease and rheumatoid arthritis: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the association between periodontitis and rheumatoid arthritis (RA) in middle-aged populations.The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of major electronic databases was conducted for studies published between 2013 and 2023. In addition, a manual search was performed to identify relevant studies examining an association between these 2 conditions. The Newcastle-Ottawa scale was used to assess the risk of bias for the included cross-sectional and case-control studies. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis, and a meta-analysis of eligible studies was conducted.A total of 11 articles were included in the systematic review, with 9 incorporated into the meta-analysis. A statistically significant positive association was observed between periodontitis and RA for clinical attachment loss (CAL). The GRADE assessment indicated low to moderate level of certainty across studies, indicating strong evidence regarding clinical parameters. The meta-analysis showed a high overall odds ratio (OR) (OR = 11.37; 95% confidence interval (95% CI): 4.22-30.61; p < 0.01), suggesting that patients with RA have a significantly higher risk of developing periodontitis. In conclusion, this systematic review and meta-analysis identified a positive association between periodontitis and RA. However, the GRADE analysis highlights the need for clinical and longitudinal studies with extended follow-up periods to further clarify this relationship and account for potential confounding factors.