Impact of PsA, Periodontitis on Quality of Life
Psoriatic arthritis (PsA) and periodontitis (PD) are two inflammatory conditions that can greatly impact a patient’s quality of life. While seemingly separate and distinct conditions, recent studies have suggested an association between the two conditions and a negative impact on oral health-related quality of life (OHRQoL), which is an intrinsic part of an individual’s overall health.
To further explore the relationship between PsA and PD, researchers conducted a comparative, cross-sectional study examining OHRQoL among patients with concomitant PsA and PD.1 Lead study author Supriya Mishra, MDS, answers questions on the study implications. Dr Mishra is an Assistant Professor in the Department of Periodontics at the Government Dental College in Chhattisgarh, India.
Consultant360: What prompted this study?
Supriya Mishra: OHRQoL is a subjective assessment of the person’s oral health, including expectations for and satisfaction with treatment, functional and emotional well-being, and sense of self. Both PD and PsA are chronic, inflammatory, and debilitating conditions that worsen with time and pose a significant disease burden and impair quality of life and physical function. In fact, recent studies have shown that PD can be a significant co-morbidity of PsA. Previously published studies show that PD and PsA individually have a significant negative impact on OHRQoL. However, there is limited knowledge and understanding about how the concurrent presence of PD in a patient with PsA can impact a patient’s OHRQoL. Based on these findings, it was interesting to carry out this study as it was an opportunity to contribute new insights in this field.
C360: Can you discuss how patient specific factors, such as age or past dental visit, impacted your study results?
SM: Several variables including age, frequency of dental visits, and usage of other oral hygiene products were found to be linked to OHRQoL in our study. For example, every 1% increase in age was associated with a 4% decrease in OHRQoL. Similarly, a 2% decrease in OHRQoL was observed in those who had not attended prior dental visits and did not utilize oral hygiene products, aside from toothbrushing. These results emphasize the importance of increased oral hygiene practices and regular dental appointments among this patient population.
C360: What should be health care practitioners’ key takeaways from this study? How should they implement these key takeaways into clinical practice?
SM: The results of our study indicated that the group of patients with concurrent presence of PD and PsA had the highest negative impact on OHRQoL. The summary scores and dimensional scores of Oral Health Impacts Profile (OHIP-14) were significantly higher in patients with both conditions when compared with individuals with PsA alone. This data may help health care practitioners to identify patients and periodontal issues that need specialized care. Further, this information may help guide tailored therapy during critical moments for patients with orofacial symptoms.
C360: Are there any interventions that health care practitioners can recommend to the patients with both psoriatic arthritis and periodontitis that may decrease the negative impact on quality of life?
SM: It is important that clinicians actively educate their patients with PsA about proper periodontal health practices and maintenance. Clinicians can encourage positive oral self-care behaviors and needed interventions through dental referrals, which should be a routine aspect of therapy for patients with PsA.
C360: What is currently known about the relationship or interactions between psoriatic arthritis and periodontitis?
SM: A few recent studies, including our previous study, have suggested a potential link between PD and PsA.2-8 A number of distinct traits are present in both conditions, including bone resorption and altered bone remodeling, cell infiltration, a heightened immune response to microorganisms living on the epidermal surface of the skin or in periodontal tissues, and shared risk factors. Some studies suggested that patients with PsA were concerned about PD. When simultaneously present, PD has the potential to negatively impact OHRQoL and functional factors, as well as adversely impact an individual’s self-esteem and social interactions.
References:
- Mishra S, Johnson LL, Kaushal L, Upadhyay. Impact of periodontitis on oral health-related quality of life of patients with psoriatic arthritis. Spec Care Dentist. Published online November 2, 2023. https://onlinelibrary.wiley.com/doi/abs/10.1111/scd.12938
- Llanos AH, Silva CGB, Ichimura KT, et al. Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life. Braz Oral Res. 2018;32:e006. Doi:10.1590/1807-3107bor-2018.vol32.0006
- Schmalz G, Patschan D, Schmickler J, et al. Oral healthrelated quality of life in different rheumatic diseases. Oral Dis. 2020;26(8):1783-1792. doi:10.1111/odi.13464
- Costa AA, Cota LOM, Mendes VS, Oliveira AMSD, Cyrino RM, Costa FO. Periodontitis and the impact of oral health on the quality of life of psoriatic individuals: a case-control study. Clin Oral Investig. 2021;25(5):2827-2836. Doi:10.1007/s00784-020-03600-1
- Egeberg A, Mallbris L, Gislason G, Hansen PR, Mrowietz U. Risk of periodontitis in patients with psoriasis and psoriatic arthritis. J Eur Acad Dermatol Venereol. 2017;31:288- 293. Doi:10.1111/jdv.13814
- Üstün K, Sezer U, Kısacık B, et al. Periodontal disease in patients with psoriatic arthritis. Inflammation. 2013;36:665-669. Doi:10.1007/s10753-012-9590-y
- Ancuta C, Ancuta E, Rodica C, Anton C, Zenaida S, Cristina I. TNF inhibitors and periodontal inflammation in psoriatic arthritis. Revista de Chimie. 2017;68:1914-1918.
- Mishra S, Johnson L, Agrawal S, Rajput S. Assessment of periodontal status in patients with psoriatic arthritis: a retrospective, case-control study. J Clin Exp Dent. 2021;13(8):e776-e783. doi:10.4317/jced.58125.