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and also has been related to the progression of inflammatory involvement in these patients 19. In contrast, in the current study we did not find a relationship between SpA and periodontitis. Patients with SpA do not share the same genetic risk factors, female predominance and disease-specific autoantibodies such as ACPAs with RA. The citrullination of proteins, which has been suggested the “link” behind the association between RA and periodontitis, is a biochemical process that has not been found relevant in the pathogenesis of SpA 20. Moreover, the prominent role of HLA-B27 in SpA has not been involved in the pathophysiology of periodontitis. To our knowledge there is no data evaluating the potential contribution of the allele HLA-B27 in the pathogenesis of periodontitis.
A potential association between SpA and periodontitis has been investigated in previous studies. In a study including 51 patients with psoriatic arthritis the frequency of periodontitis was similar and statistically not different compared with control subjects (41 vs. 38% respectively) (p=0.90) 21. In contrast, a case-control study in Germany including 48 patients with AS reported a significantly higher risk of periodontal disease compared to controls (OR= 5.4, CI 95% 1.4-22.0) 22. However, the case definition of periodontal disease in this study was based on a clinical measure (CAL≥3mm) instead of a clinical diagnosis or established criteria. Moreover, a study using administrative claims data sourced from the National Health Insurance program in Taiwan reported that AS patients are 1.8 times more likely than controls to have a previous diagnosis of chronic periodontitis (OR= 1.8, CI 95% 1.7-1.9). However, all the cases of periodontitis analyzed in this study were sourced from an administrative database, which may be less accurate than a clinical diagnosis made by periodontologists. Recently, a systematic review and meta-analysis including six case-control studies reported a prevalence rate of periodontitis that ranged from 38% to 88% in AS patients vs. a range from 26% to 71% in controls 23. Although the authors report an increasing risk of AS associated with periodontitis (OR=1.85, CI 95% 1.7-1.9), the potential confounding factors, high level of heterogeneity and methodological weakness among the few eligible studies may limit the interpretation of the results. Moreover, the different case-definitions of periodontitis used in these studies may have influenced the prevalence of periodontitis and hamper to establish clear associations and comparisons between studies.
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