Prevalence of periapical abscesses in patients with rheumatoid arthritis. A cross sectional study.

Purpose: To assess the prevalence of periapical abscesses in patients with rheumatoid arthritis, and to evaluate the effect of commonly used antirheumatic medications on such prevalence.

Methods: Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for rheumatoid arthritis and periapical abscess was retrieved by searching the appropriate query in the database. The odd ratio (OR) of periapical abscesses, its association with rheumatoid arthritis and intake of three commonly prescribed antirheumatic medications were calculated and analyzed statistically.

Results: The prevalence of periapical abscesses in patients with rheumatoid arthritis was 1.53% as compared to 0.51% in the general patient population of the hospital. The OR was 2.60 and the difference was statistically significant (P< 0.0001). In patients treated with either Methotrexate, Sulfasalazine, or Etanercept, the ORs were 2.88, 3.1, and 1.07, respectively. The differences between Methotrexate and Sulfasalazine were statistically significant (P< 0.0001). The OR for prevalence of periapical abscesses in patients treated with Etanercept was significantly lower than that of patients treated with either Methotrexate or Sulfasalazine (P< 0.005).

Clinical Significance: Oral healthcare providers should be aware of the possible association between rheumatoid arthritis and occurrence of periapical abscesses. Patients with rheumatoid arthritis, mainly women, may exhibit higher prevalence of periapical abscesses. Treatment with TNF alpha inhibitors may lower the prevalence of periapical abscesses in such patients.