THU0691 Association between periodontitis and clinical response in rheumatoid arthritis patients under biological treatment

Background Previous studies showed that periodontitis (PD) was a propagation factor for the severity of rheumatoid arthritis (RA) and our previous epidemiological study revealed that PD was associated with discontinuation risk of etanercept. Objectives To investigate the association between PD and the risk of 3 month clinical non-response using the Disease Activity Score (DAS)-based European League Against Rheumatism (EULAR) response criteria in RA patients under biological therapy. Methods We enrolled 111 RA patients treated with biologics, including etanercept (n=16), adalimumab (n=44), golimumab (n=7), tocilizumab (n=23), abatacept (n=14), and rituximab (n=7). A qualified periodontist performed the periodontal assessment, and the 3 month clinical response was determined DAS-based EULAR response criteria. We quantified the association between PD and the risk of non-response by calculating odds ratios (ORs) with 95% confidence intervals (CIs) using the logistic regression analysis, after adjusting for confounders including age, sex, tobacco use, RA disease duration, biologic treatment duration, rheumatoid factor and anti-citrullinated peptide antibody, erythrocyte sedimentation rate and C-reactive protein, concurrent medication, and diabetes. Results Of 111 RA patients, 83 (74.8%) had PD. 37 (44.6%) of PD patients received periodontal treatment within three months. After adjusting for potential confounders, PD patients had a higher risk of non-response to treatment than non-PD patients (OR, 4.20; 95% CI, 1.06–16.68; p=0.041). Compared with non-PD patients, the risk of non-response was significantly greater in PD patients who did not receive periodontal therapy (OR, 5.12; 95% CI, 1.16–22.56; p=0.031), but not in PD patients who received periodontal therapy (OR, 3.28; 95% CI, 0.72–15.06; p=0.126). Among those who were under under tumour necrosis factor inhibitor therapy (n=67), the risk of clinical non-response was markedly higher in those with PD (OR, 9.65; 95% CI, 1.33–70.04; p=0.025), particularly in those who did not receive periodontal therapy (OR, 14.39; 95% CI, 1.59–130.38; p=0.018). Conclusions In RA patients under biological therapy, an increased risk of clinical non-response to treatment was observed in patients with PD, especially among those who did not receive periodontal treatment. Reference [1] Chen HH, Chen DY, Lai KL, Chen YM, Chou YJ, Chou P, et al. Periodontitis and etanercept discontinuation risk in anti-tumor necrosis factor-naive rheumatoid arthritis patients: a nationwide population-based cohort study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases2013;19(8):432–8. Acknowledgements The authors would like to thank the Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, ROC for statistical support. Disclosure of Interest None declared