Screening of dental and sinus infections in rheumatoid arthritis.

BACKGROUND Rheumatoid arthritis (RA) is associated with increased risk of infections. Screening for oral (dental and/or sinus) infection could be proposed before biologic disease-modifying antirheumatic drugs (bDMARDs) initiation but is not systematically recommended. The aim of our study was to assess the prevalence of oral infection in RA patients requiring bDMARDs. MATERIALS AND METHODS This was a monocentric retrospective study. We included patients with RA and active disease requiring bDMARDs. Dental infection and sinusitis were assessed by a stomatologist and otorhinolaryngologist after clinical, panoramic dental X- ray and sinus CT evaluation. Factors associated with oral infections were analyzed in uni- and multivariate models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS We included 223 RA patients (79.4% female, mean disease duration 8.9 ±8.6 years). The mean age was 54.4 ±10.9 years and mean Disease Activity Score in 28 joints 5.5 ±2.6. Systematic dental screening revealed infection requiring treatment before bDMARDs initiation in 46 (20.9%) patients. Sinusitis was diagnosed by the otorhinolaryngologist in 33 (14.8%) patients. Among the 223 patients, 69 (30.9%) had dental and/or sinus infection. On univariate analysis, active smoking was associated with increased probability of oral infection (OR=2.16 [95% CI 1.02-4.57], p=0.038) and methotrexate with reduced probability (OR=0.43 [95% CI 0.23-0.81], p=0.006). On multivariate analysis, no RA variables were associated with oral infection. CONCLUSION In our study, asymptomatic oral infection was confirmed in one third of RA patients.