Prevalence and determinants of periodontitis among a population with knee osteoarthritis at the Douala General Hospital (Littoral, Cameroon)

Prevalence and determinants of periodontitis among a population with knee osteoarthritis at the Douala General Hospital (Littoral, Cameroon) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and determinants of periodontitis among a population with knee osteoarthritis at the Douala General Hospital (Littoral, Cameroon) Herna Stella CHIMY TCHOUNCHUI, Fernando KEMTA LEKPA, Sylvain Raoul SIMENI NJONNOU, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5943034/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Osteoarthritis (OA) is a slowly evolving multifactorial disorder that affects joints, particularly the knee. Periodontitis is an infection of the tissues supporting the teeth, leading to significant tooth loss. Recent studies suggest an association between Knee OA (KOA) and periodontitis, with the prevalence of periodontitis increasing with the severity of KOA. We aimed to determine the prevalence and distribution of periodontitis and the association between the severity of KOA and periodontitis in subjects living with KOA. Patients and methods: A cross-sectional study was conducted in an outpatient clinic at the Rheumatology unit of the Douala General Hospital between October 2022 and June 2023. Data were collected using a questionnaire, an endo-buccal examination grid, radiological images and medical records. A multivariate analysis using logistic regression was performed, including the relevant variables in the bivariate analysis. Results We included 253 participants (201 women) with a median age of 63 years [54–70]. The mean VAS was 52.7 ± 27.9 mm. The mean Lequesne index was 12.25 ± 5.03. Kellgren and Lawrence (K&L) grade 2 was predominant (61.7%), as was tricompartimental KOA (85.4%). The prevalence of periodontitis was 62.5%. Periodontitis was significantly associated with radiological K&L grade 4 (OR: 5.39 [1.27–28.98]; p = 0.03), poor oral hygiene (OR: 34 [7.46277.71]; p < 0.001), visits to the dentist [in case of problems] (OR: 8.54 [3.09–28.58]; p < 0.001) and brushing time (OR: 21.93 [5.66-123.24]; p < 0.001). Conclusion Periodontitis is common in patients with KOA in Cameroon and is associated with the severity of KOA and poor oral hygiene. Knee osteoarthritis periodontitis prevalence determinants Figures Figure 1 Figure 2 Figure 3 Introduction Knee osteoarthritis (KOA) is the most common type of osteoarthritis (OA) of the limbs and one of the leading causes of disability [ 1 , 2 ]. Previously, OA was considered as a “degenerative” disease, the inevitable accompaniment of aging, with a wear-and-tear” as the main pathogenic mechanism [ 1 ]. Now, the pathogenesis of OA continues to evolve, moving from a cartilage-limited to a multifactorial disease that affects the whole joint [ 2 ]. Indeed, OA is increasingly seen as a metabolically active and dynamic process arising from an imbalance between the repair and destruction of joint tissues, which may be triggered by a variety of mechanical and biochemical insults [ 1 , 2 ]. Accumulating evidence indicates that chronic and low-grade joint inflammation, mediated primarily by the innate immune system and to a lesser degree adaptive immune system has a critical role in the pathogenesis of OA [ 3 ]. In addition to co-morbidities such as obesity, excessive joint stress triggers inflammation of the cartilage with subsequent degradation, mediated by the release of inflammatory and extracellular cartilage matrix degrading factors such as cytokines, nitric oxide, toll-like receptors, and matrix metalloproteinases [ 3 , 4 ]. In addition, complement activation is thought to play an essential role by affecting the expression of inflammatory and degradative molecules in joints [ 3 , 4 ]. Periodontitis is another disease whose pathogenesis is mediated by the inflammatory complement cascade [ 5 ]. Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the periodontium and alveolar bone caused by biofilm-forming micro-organisms (6). Its primary features include the loss of periodontal tissue support, manifested through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, the presence of periodontal pocketing (PP) and gingival bleeding [ 6 ]. The relationship between periodontitis and chronic inflammatory rheumatic diseases like rheumatoid arthritis (RA) and osteoporosis is well documented [ 7 ]. There is scarce information about the link between periodontitis and OA. Data suggests a time-dependent bidirectional pattern between KOA and periodontitis [ 8 – 12 ], and the more severe the KOA, the stronger the association [ 9 – 11 ]. To our knowledge, there are no African studies on periodontitis in OA. This led us to investigate the prevalence and determinants of periodontitis in patients with symptomatic KOA in a teaching hospital in Cameroon, as well as the association between the severity of KOA and periodontitis. Patients and Methods Study design We performed a hospital-based cross-sectional study and a nested case-control study with prospective recruitment over 09 months (from October 2022 to June 2023) at the Rheumatology unit of the Douala General Hospital, Cameroon. Participants and sampling Our source population consisted of patients aged 30 and over followed up or newly diagnosed for KOA defined according to the ACR [ 13 ], EULAR [ 14 ] criteria, or NICE guidance [ 15 ], and with a radiographic grade of Kellgren and Lawrence ≥ 2 [ 16 ]. Using a prevalence of 9.9% [ 17 ], our minimum sample size was calculated as 138 individuals for the descriptive component and 178 individuals (1:1), i.e. 89 cases and 89 controls, for the analytical component. For the descriptive part of our study, we included all patients with KOA who meet the following criteria: i) have at least 50% of their teeth present in the mouth ii) have given their consent to participate in the study. Patients who had undergone periodontal therapy in the previous 6 months or with a knee infection or trauma or pregnant women were not included. Concerning the analytical part, match by age and sex, cases were defined as patients with KOA with at least 50% of teeth present in the mouth, who have not received periodontal therapy in the last six months, and with findings consistent with periodontitis [ 6 ]. Controls were patients with KOA with at least 50% of teeth present in the mouth, who have not received periodontal therapy in the last six months, and without periodontitis [ 6 ]. Data collection and procedures All methods related to the study were performed in accordance with the Declaration of Helsinki. The research protocol of the study was approved by the regional ethics committee (n° 2023/6/CE/CRERSH-LITTORAL) and research authorization from the institutional board of the Douala General Hospital (n°033/AR/MINSANTE/HGD/DM/02/23). Consecutive sampling methods were used to recruit outpatients with KOA. All participants were informed of the objectives and procedures of the study and only those who consented to participate were included, interviewed and examined. Informed consent was validated by a signature of a consent form. We recorded in a pre-tested questionnaire socio-demographic data, clinical data, particularly KOA-related data (including a visual analog scale for pain, Lequesne's algo-functional index [ 18 ], and Kellgren and Lawrence classification [ 16 ]), oral and dental hygiene habits (using the Silness and Loé plaque index [ 19 ]). Pocket depth and CAL were all assessed on endobuccal examination. The periodontal examination was performed by 2 dental surgeons (HSCT, CDB) to ensure the reliability of our data and to determine the Kappa index. For those participants whose difference was greater than one grade, the opinion of a third dental surgeon (LEEB) was taken. A preliminary scaling was carried out in patients with excess tartar to better assess the PP and CAL. The prevalence of periodontitis and its severity were estimated based on the CAL: stage I or early periodontitis for the site with the largest CAL ˂ 3 mm; stage II or moderate periodontitis for a CAL [3–5[ mm; and stage III or severe periodontitis for a CAL ≥ 5 mm [ 6 ]. Variables The study variables were: - Sociodemographic: age, gender, occupation, monthly income, residence, marital status, level of education. - Variables related to oral health education needs Time of brushing, means used for brushing, frequency of brushing, duration of brushing, frequency of annual visits to the dentist. - Co-morbidities: Hypertension, diabetes mellitus, hyperuricemia, epilepsy, peptic ulcer disease (PUD), cancer, gastro-oesophageal reflux disease (GERD), HIV, Hepatitis B virus infection, Hepatitis C virus infection, smoking and alcohol consumption. - Endo-buccal examination variables: oral hygiene (plaque index), periodontal status (EFP/AAP). - Radiographic variables of KOA: Kellgren and Lawrence index, location and lesions of KOA. - Clinical and anthropometric variables: weight, height, BMI (Body Mass Index), pain (VAS, schedule, site), blood pressure and menopause. - Variables related to risk factors for KOA: history of trauma, age, sex, menopause, obesity, knee arthritis, family history of KOA. - Variables related to the severity of KOA: Lequesne’s algo-functional index. - Variables related to other rheumatological conditions: digital osteoarthritis, lumbar osteoarthritis, scapulohumeral osteoarthritis, and coxarthrosis. Statistical analysis All statistical analyses were performed using SPSS Statistics version 23.0 (IBM Statistics, Armonk, NY, USA) with significance levels set at α < 0.05. Quantitative variables were described by means (± standard deviation), or by medians (interquartile ranges). Qualitative variables were described as numbers (percentages). The Chi-square test and Fischer's exact test were used to compare categorical variables in the bivariate analysis. To eliminate confounding factors such as age, weight and BMI, a multivariate analysis using logistic regression was performed, enabling us to determine the factors associated with periodontitis in our sample. The adjusted odds ratio (ORa) enabled us to identify the risk factors for periodontitis in patients with KOA with a 95% confidence interval. We included in the regression model the relevant variables with an association with periodontitis in bivariate analysis. Results Baseline characteristics of participants with KOA Of the 296 patients with KOA received during the study period, 263 (52 men) were included. The flow chart shows the progression of participants throughout the study (Fig. 1 ). The median age was 63 years [IQ 54–70]. BMI was 32.67 ± 7.73 Kg/m 2 . The mean pain VAS was 52.7 ± 27.9 mm with 62.5% of patients having a pain VAS > 40 mm. The mean Lequesne’s index was 12.25 ± 5.03. Extremely severe disability was found in 40.7% of participants. Two-thirds of our participants had K&L grade 2 (61.6%). Table I shows the baseline characteristics of the study population. The quality of oral hygiene in our series was average in 127 (50.2%) participants (Fig. 2 ). Brushing methods were bad in 151 (59.7%) participants. Table II describes the participant' knowledge of dental disease and their oral hygiene. The mean kappa score for periodontal examination was 1. Prevalence and determinants of periodontitis The diagnosis of periodontitis was made in 158 patients (62.5%). The distribution of the severity of periodontitis is shown in Fig. 3 . Moderate periodontitis accounted for 57.6% of the patients. Table III shows the factors associated with the presence of periodontitis, after bivariate and multivariate analysis. In bivariate analysis, the factors significantly associated with periodontitis included: level of education, overweight, housewife, K&L grade 4, severe pain, moderate disability, hypertension, annual visit to the dentist in the event of a problem, and poor brushing duration, and poor oral hygiene (tables I and II). However, in multivariate analysis, factors that independently influenced the presence of periodontitis included: K&L grade 4 (ORa: 5.39 [1.27–28.98]; p = 0.03), annual visit to the dentist in the case of a problem (ORa: 8.54 [3.09–28.58]; p < 0.001), poor brushing duration (ORa: 21.93 [5.66–123.24]; p < 0.001), poor oral hygiene (OR a: 34.92 [7.46–277.71]; p < 0.001). Discussion To the best of our knowledge, this is the first study to demonstrate that periodontitis is associated with KOA in an African setting. We found periodontitis in two-thirds of our patients with KOA. This prevalence is higher than those previously described varying between 26% and 54.6% [ 10 – 12 ]. This elevated prevalence could be explained mainly by the greatest prevalence and impact of periodontitis in Africa, probably as a result of the burden of infections [ 20 , 21 ], the design of each study and the older age of participants. Specifically, and as in a previous study [ 10 ], we showed that periodontitis was significantly associated with poor oral health-related behaviors and limited access to dental care. Although the prevalence of periodontitis is lower in KOA than in RA (22–24) [ 22 – 24 ], KOA joins inflammatory rheumatic diseases and bone diseases in their association with periodontitis. While, like us, some studies have observed periodontitis in patients with KOA, other studies have shown that periodontitis can precede the onset of KOA. When asked "Who is the chicken and who is the egg", a recent study suggested that an increased risk of periodontitis and KOA were observed for patients with either disease [ 8 ]. This association would be associated with the severity of KOA and/or periodontitis [ 8 , 10 ]. In our study, this link with the severity of OA was only found for severe structural damage and not for pain and disability. This discrepancy is also found in certain studies [ 10 , 12 ]. We are unable to say whether the radio-clinical dissociation in OA could explain this discrepancy. Nevertheless, previous studies globally suggested that periodontitis is associated with the presence of KOA [ 8 – 12 ], structural severity of KOA leading to prosthetic surgery [ 9 – 11 ] and type 2 diabetes might be a booster of this relationship [ 9 ]. However, a two-sample bidirectional Mendelian randomization analysis using publicly released genome-wide association studies (GWAS) statistics did not demonstrate a causal effect of genetically predicted periodontitis and OA, neither did genetically predicted OA on periodontitis [ 25 ]. Nevertheless, apart from the complement pathway, some other pathways could explain the link between periodontitis and KOA. In a mouse model of OA, greater alveolar bone loss was found in cases of periodontitis [ 26 ]. Also, the same bacterial DNA has been found in the periodontal tissue and synovial fluid of patients with OA [ 27 ]. These suggest that bacterial pathogens causing periodontitis might spread to joints through the bloodstream [ 28 ] and/or bacterial lipopolysaccharides may increase the risk of individuals developing OA [ 27 ]. These findings support the hypothesis that periodontal pathogens could modify the homeostasis of the joint via a direct effect or a cross-reaction with immunologic tolerance of the bacterial biofilm acting on the cartilage and surrounding tissues. In addition, an Omics-based study has identified gene signatures as common significant biomarkers/targets associated with the molecular mechanism of periodontitis, RA and OA [ 29 ]. Otherwise, promising results already suggest the efficacy of certain symptomatic slow-acting drugs for OA in periodontitis [ 11 , 30 ]. Conversely, introducing a conditioned medium from periodontal ligament-derived stem cells to osteoarthritic joints could be a potential treatment to prevent OA progression by inhibiting inflammation [ 31 ]. Further studies are needed to appreciate if specific treatment of periodontitis or KOA might be effective for patients with either disease. Also, it will be interesting to know whether improving oral health-related behaviors and access to oral health care could be a solution to reduce the prevalence and severity of both periodontitis and KOA. In the meantime, clinicians treating OA should consider the need for dental care for their patients [ 11 ]. This study has three main limitations. Using a cross-sectional study design does not allow us to demonstrate a cause-and-effect relationship between periodontitis and OA and evidence for the bidirectional nature of the association, as would have been possible with a prospective cohort study. Performing bacteriological samples from the knee and oral cavity would have provided further evidence in favor of this link. However, for ethical reasons, samples from the knee can be taken globally during surgery, which was not the case for the patients in our study. The non-randomized sampling technique related to the hospital-based design is a major selection bias. Then, the findings of this study cannot be generalized without caution. In conclusion, we found that severe periodontitis is significantly associated with KOA and poor oral hygiene. We are waiting for studies to indisputably demonstrate the link between KOA and periodontitis. Until then, there is a need to improve oral health-related behaviors and access to oral health care for patients with KOA. Abbreviations AAP: American Association of Periodontology ACR: American Collège of Rheumatology ADA: American Diabetes Association BMI: Body Mass Index CAL: Loss of Clinical Attachment DPSI: Dutch Periodontal Screening Index EFP: European Federation of Periodontology HBP: High Blood Pressure K&L: Kellgren and Lawrence KOA: Knee Osteoarthritis MOH: Motivation for Oral Hygiene NICE: National Institute for Health and Care Excellence PLHIV: Patient Living with HIV PP: Periodontal Pocket SPSS: Statistical Package for Social Sciences VAS: Visual Analog Scale Declarations Ethics approval and consent to participate: We have obtained an ethical clearance from the Ethical Regional Committee for the Littoral Region (n° 2023/6/CE/CRERSHLITTORAL) and research authorization from the institutional board of the Douala General Hospital (n°033/AR/MINSANTE/HGD/DM/02/23). We conducted this study in strict compliance with the fundamental principles of scientific research in medicine. Patients were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant. Consent to publish : Not Applicable Data and document availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Conflict of interests: The authors state they have no competing interests. Funding : No funding was received for this study. Author’s contribution : Design and design: HSCT, FKL, SRSN, CMT, JA. Data collection: HSCT, FKL, SRSN, CDN, LEEB. Data analysis and interpretation: CDN, HSCT, FKL, SRSN. Manuscript writing: HSCT, FKL, SRSN, CMT, CDN, FAT, SPC. Manuscript revision: HSCT, FBS, FKL, SRSN, CMT, LEEB, SPC. All authors read and approve the final version for publication. Acknowledgments : An earlier version of this manuscript was presented as an abstract entitled Prévalence et déterminants des parodontites chez les sujets suivis pour gonarthrose au Cameroun at The French Congress of Rheumatology (December 2023, Paris, France). according to the following link: https://www.sciencedirect.com/science/article/abs/pii/S1169833023007676; doi: 10.1016/j.rhum.2023.10.394 We thank the participants and all the Rheumatology and Stomatology Units of the Douala General Hospital staff and its Director Pr Henri Nname Luma. Clinical trial number: not applicable. Author informations: · Herna Stella CHIMY TCHOUNCHUI : [email protected] ; ORCID: 0009-0006-3719-1754 · Fernando KEMTA LEKPA: [email protected] ;ORCID: 0000-0001-7592-5049 · Sylvain Raoul SIMENI NJONNOU: [email protected] ; ORCID: 0000-0002-5050-566X · Clarisse MAPA-TASSOU : [email protected] ; ORCID : 0000-0002-0709-1449 · Christian DEUBE NGAKO: [email protected] , ORCID : 0009-0004-4667-6396 · Faustin ATEMKENG TSATEDEM : [email protected] , ORCID : 0000-0002-3530-2637 · Félicité SOH MALEU MBAH: [email protected] , ORCID: 0009-0006-7383-2942 · Lawrence ESSAMA ENO BELINGA: [email protected] , ORCID : 0000-0003-2204-6686 · Francine SAME BEBEY: [email protected] , ORCID: 0000-0001-7882-354X ·Jerome ATEUDJIEU : [email protected] , ORCID : 0000-0002-2156-1160 · Siméon Pierre CHOUKEM : [email protected] , ORCID : 0000-0003-1399-5513 References Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759. doi: 10.1016/S0140-6736(19)30417-9. PMID: 31034380. Sharma L. 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Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1to3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5943034","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":412543738,"identity":"c4918ab2-dec7-4206-b595-f78284f7583a","order_by":0,"name":"Herna Stella CHIMY TCHOUNCHUI","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Herna","middleName":"Stella CHIMY","lastName":"TCHOUNCHUI","suffix":""},{"id":412543739,"identity":"6f7fcf77-e003-4262-9bf8-138196661d30","order_by":1,"name":"Fernando KEMTA LEKPA","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"KEMTA","lastName":"LEKPA","suffix":""},{"id":412543740,"identity":"bb30790c-cf0c-4060-b596-6769f2634548","order_by":2,"name":"Sylvain Raoul SIMENI NJONNOU","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYLCCBwwSDAzsDQzMIA6QJgIkgLTwHIBoAdJEaQECiQQitZi3Hz4mkfDHIlp+5hvDzwUVNgw80gT0yJxJS5NIbJPI3XA7x1h6xpk0Bh6+BPxaJBhyzCQSG4BapHMMpHnbDjPY8xBwmAT/GzOgwyRy5888Y/wbpIWHoBYJoC0JbBK5DTd4zKSJ1PIs2QLslzNpZdY8Z9J4CGvhTz5448Ofutz57Yc33+apsJEjqAUJcBiASBI0AFPKA1JUj4JRMApGwQgCAKNYOn/71rL+AAAAAElFTkSuQmCC","orcid":"","institution":"University of Dschang","correspondingAuthor":true,"prefix":"","firstName":"Sylvain","middleName":"Raoul SIMENI","lastName":"NJONNOU","suffix":""},{"id":412543741,"identity":"82b1e262-0d54-483b-986e-2f5e8da289fd","order_by":3,"name":"Clarisse 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Dschang","correspondingAuthor":false,"prefix":"","firstName":"Jérôme","middleName":"","lastName":"ATEUDJIEU","suffix":""},{"id":412543748,"identity":"e2488cbd-b40b-4518-a643-383b16980596","order_by":10,"name":"Simeon Pierre CHOUKEM","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Simeon","middleName":"Pierre","lastName":"CHOUKEM","suffix":""}],"badges":[],"createdAt":"2025-02-01 17:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5943034/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5943034/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75898290,"identity":"4530b270-ba09-4be8-922a-e0aba0e6c0bd","added_by":"auto","created_at":"2025-02-10 10:45:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143608,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of participants according to the quality of their oral hygiene\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5943034/v1/c2c5d9ec72c1712d5fcb0800.png"},{"id":75899226,"identity":"077f457a-23f1-4165-94ec-f51169ecd98f","added_by":"auto","created_at":"2025-02-10 10:53:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":122998,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of periodontitis in subjects with knee osteoarthritis in our study population\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5943034/v1/794a4b68f80ef9396eed6810.png"},{"id":75899232,"identity":"f6fed013-339c-4c50-b967-62fb05be78a2","added_by":"auto","created_at":"2025-02-10 10:53:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":158410,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the severity of periodontitis\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5943034/v1/da00a1d412edd515a944d55c.png"},{"id":76139141,"identity":"e346b001-fd10-4d62-9c28-7f97c62179d1","added_by":"auto","created_at":"2025-02-12 17:02:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":992883,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5943034/v1/6b63d083-2df7-41d8-a1f9-e0e20113be09.pdf"},{"id":75898286,"identity":"8554585d-9d1d-4996-87ca-83631dadd4c4","added_by":"auto","created_at":"2025-02-10 10:45:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":78139,"visible":true,"origin":"","legend":"","description":"","filename":"Table1to3.docx","url":"https://assets-eu.researchsquare.com/files/rs-5943034/v1/014b8e32fc63bf1173b4154b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and determinants of periodontitis among a population with knee osteoarthritis at the Douala General Hospital (Littoral, Cameroon)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKnee osteoarthritis (KOA) is the most common type of osteoarthritis (OA) of the limbs and one of the leading causes of disability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Previously, OA was considered as a \u0026ldquo;degenerative\u0026rdquo; disease, the inevitable accompaniment of aging, with a wear-and-tear\u0026rdquo; as the main pathogenic mechanism [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Now, the pathogenesis of OA continues to evolve, moving from a cartilage-limited to a multifactorial disease that affects the whole joint [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Indeed, OA is increasingly seen as a metabolically active and dynamic process arising from an imbalance between the repair and destruction of joint tissues, which may be triggered by a variety of mechanical and biochemical insults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Accumulating evidence indicates that chronic and low-grade joint inflammation, mediated primarily by the innate immune system and to a lesser degree adaptive immune system has a critical role in the pathogenesis of OA [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition to co-morbidities such as obesity, excessive joint stress triggers inflammation of the cartilage with subsequent degradation, mediated by the release of inflammatory and extracellular cartilage matrix degrading factors such as cytokines, nitric oxide, toll-like receptors, and matrix metalloproteinases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, complement activation is thought to play an essential role by affecting the expression of inflammatory and degradative molecules in joints [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeriodontitis is another disease whose pathogenesis is mediated by the inflammatory complement cascade [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the periodontium and alveolar bone caused by biofilm-forming micro-organisms (6). Its primary features include the loss of periodontal tissue support, manifested through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, the presence of periodontal pocketing (PP) and gingival bleeding [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe relationship between periodontitis and chronic inflammatory rheumatic diseases like rheumatoid arthritis (RA) and osteoporosis is well documented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There is scarce information about the link between periodontitis and OA. Data suggests a time-dependent bidirectional pattern between KOA and periodontitis [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and the more severe the KOA, the stronger the association [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. To our knowledge, there are no African studies on periodontitis in OA. This led us to investigate the prevalence and determinants of periodontitis in patients with symptomatic KOA in a teaching hospital in Cameroon, as well as the association between the severity of KOA and periodontitis.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eWe performed a hospital-based cross-sectional study and a nested case-control study with prospective recruitment over 09 months (from October 2022 to June 2023) at the Rheumatology unit of the Douala General Hospital, Cameroon.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and sampling\u003c/h3\u003e\n\u003cp\u003eOur source population consisted of patients aged 30 and over followed up or newly diagnosed for KOA defined according to the ACR [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], EULAR [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] criteria, or NICE guidance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and with a radiographic grade of Kellgren and Lawrence\u0026thinsp;\u0026ge;\u0026thinsp;2 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUsing a prevalence of 9.9% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], our minimum sample size was calculated as 138 individuals for the descriptive component and 178 individuals (1:1), i.e. 89 cases and 89 controls, for the analytical component. For the descriptive part of our study, we included all patients with KOA who meet the following criteria: i) have at least 50% of their teeth present in the mouth ii) have given their consent to participate in the study. Patients who had undergone periodontal therapy in the previous 6 months or with a knee infection or trauma or pregnant women were not included. Concerning the analytical part, match by age and sex, cases were defined as patients with KOA with at least 50% of teeth present in the mouth, who have not received periodontal therapy in the last six months, and with findings consistent with periodontitis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Controls were patients with KOA with at least 50% of teeth present in the mouth, who have not received periodontal therapy in the last six months, and without periodontitis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData collection and procedures\u003c/h3\u003e\n\u003cp\u003e All methods related to the study were performed in accordance with the Declaration of Helsinki. The research protocol of the study was approved by the regional ethics committee (n\u0026deg; 2023/6/CE/CRERSH-LITTORAL) and research authorization from the institutional board of the Douala General Hospital (n\u0026deg;033/AR/MINSANTE/HGD/DM/02/23). Consecutive sampling methods were used to recruit outpatients with KOA. All participants were informed of the objectives and procedures of the study and only those who consented to participate were included, interviewed and examined. Informed consent was validated by a signature of a consent form.\u003c/p\u003e \u003cp\u003eWe recorded in a pre-tested questionnaire socio-demographic data, clinical data, particularly KOA-related data (including a visual analog scale for pain, Lequesne's algo-functional index [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and Kellgren and Lawrence classification [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]), oral and dental hygiene habits (using the Silness and Lo\u0026eacute; plaque index [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003ePocket depth and CAL were all assessed on endobuccal examination. The periodontal examination was performed by 2 dental surgeons (HSCT, CDB) to ensure the reliability of our data and to determine the Kappa index. For those participants whose difference was greater than one grade, the opinion of a third dental surgeon (LEEB) was taken. A preliminary scaling was carried out in patients with excess tartar to better assess the PP and CAL. The prevalence of periodontitis and its severity were estimated based on the CAL: stage I or early periodontitis for the site with the largest CAL ˂ 3 mm; stage II or moderate periodontitis for a CAL [3\u0026ndash;5[ mm; and stage III or severe periodontitis for a CAL\u0026thinsp;\u0026ge;\u0026thinsp;5 mm [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe study variables were:\u003c/p\u003e\n\u003cp\u003e- Sociodemographic: age, gender, occupation, monthly income, residence, marital status, level of education.\u003c/p\u003e\n\u003cp\u003e- Variables related to oral health education needs Time of brushing, means used for brushing, frequency of brushing, duration of brushing, frequency of annual visits to the dentist.\u003c/p\u003e\n\u003cp\u003e- Co-morbidities: Hypertension, diabetes mellitus, hyperuricemia, epilepsy, peptic ulcer disease (PUD), cancer, gastro-oesophageal reflux disease (GERD), HIV, Hepatitis B virus infection, Hepatitis C virus infection, smoking and alcohol consumption.\u003c/p\u003e\n\u003cp\u003e- Endo-buccal examination variables: oral hygiene (plaque index), periodontal status (EFP/AAP).\u003c/p\u003e\n\u003cp\u003e- Radiographic variables of KOA: Kellgren and Lawrence index, location and lesions of KOA.\u003c/p\u003e\n\u003cp\u003e- Clinical and anthropometric variables: weight, height, BMI (Body Mass Index), pain (VAS, schedule, site), blood pressure and menopause.\u003c/p\u003e\n\u003cp\u003e- Variables related to risk factors for KOA: history of trauma, age, sex, menopause, obesity, knee arthritis, family history of KOA.\u003c/p\u003e\n\u003cp\u003e- Variables related to the severity of KOA: Lequesne\u0026rsquo;s algo-functional index.\u003c/p\u003e\n\u003cp\u003e- Variables related to other rheumatological conditions: digital osteoarthritis, lumbar osteoarthritis, scapulohumeral osteoarthritis, and coxarthrosis.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS Statistics version 23.0 (IBM Statistics, Armonk, NY, USA) with significance levels set at \u0026alpha;\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Quantitative variables were described by means (\u0026plusmn;\u0026thinsp;standard deviation), or by medians (interquartile ranges). Qualitative variables were described as numbers (percentages). The Chi-square test and Fischer\u0026apos;s exact test were used to compare categorical variables in the bivariate analysis.\u003c/p\u003e\n\u003cp\u003eTo eliminate confounding factors such as age, weight and BMI, a multivariate analysis using logistic regression was performed, enabling us to determine the factors associated with periodontitis in our sample. The adjusted odds ratio (ORa) enabled us to identify the risk factors for periodontitis in patients with KOA with a 95% confidence interval. We included in the regression model the relevant variables with an association with periodontitis in bivariate analysis.\u003c/p\u003e\n"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics of participants with KOA\u003c/h2\u003e \u003cp\u003eOf the 296 patients with KOA received during the study period, 263 (52 men) were included. The flow chart shows the progression of participants throughout the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The median age was 63 years [IQ 54\u0026ndash;70]. BMI was 32.67\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73 Kg/m\u003csup\u003e2\u003c/sup\u003e. The mean pain VAS was 52.7\u0026thinsp;\u0026plusmn;\u0026thinsp;27.9 mm with 62.5% of patients having a pain VAS\u0026thinsp;\u0026gt;\u0026thinsp;40 mm. The mean Lequesne\u0026rsquo;s index was 12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03. Extremely severe disability was found in 40.7% of participants. Two-thirds of our participants had K\u0026amp;L grade 2 (61.6%). Table I shows the baseline characteristics of the study population.\u003c/p\u003e \u003cp\u003e The quality of oral hygiene in our series was average in 127 (50.2%) participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Brushing methods were bad in 151 (59.7%) participants. Table II describes the participant' knowledge of dental disease and their oral hygiene. The mean kappa score for periodontal examination was 1.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrevalence and determinants of periodontitis\u003c/h3\u003e\n\u003cp\u003eThe diagnosis of periodontitis was made in 158 patients (62.5%). The distribution of the severity of periodontitis is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Moderate periodontitis accounted for 57.6% of the patients.\u003c/p\u003e \u003cp\u003eTable III shows the factors associated with the presence of periodontitis, after bivariate and multivariate analysis. In bivariate analysis, the factors significantly associated with periodontitis included: level of education, overweight, housewife, K\u0026amp;L grade 4, severe pain, moderate disability, hypertension, annual visit to the dentist in the event of a problem, and poor brushing duration, and poor oral hygiene (tables I and II). However, in multivariate analysis, factors that independently influenced the presence of periodontitis included: K\u0026amp;L grade 4 (ORa: 5.39 [1.27\u0026ndash;28.98]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), annual visit to the dentist in the case of a problem (ORa: 8.54 [3.09\u0026ndash;28.58]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), poor brushing duration (ORa: 21.93 [5.66\u0026ndash;123.24]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), poor oral hygiene (OR a: 34.92 [7.46\u0026ndash;277.71]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study to demonstrate that periodontitis is associated with KOA in an African setting. We found periodontitis in two-thirds of our patients with KOA. This prevalence is higher than those previously described varying between 26% and 54.6% [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This elevated prevalence could be explained mainly by the greatest prevalence and impact of periodontitis in Africa, probably as a result of the burden of infections [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the design of each study and the older age of participants. Specifically, and as in a previous study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], we showed that periodontitis was significantly associated with poor oral health-related behaviors and limited access to dental care.\u003c/p\u003e \u003cp\u003eAlthough the prevalence of periodontitis is lower in KOA than in RA (22\u0026ndash;24) [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], KOA joins inflammatory rheumatic diseases and bone diseases in their association with periodontitis. While, like us, some studies have observed periodontitis in patients with KOA, other studies have shown that periodontitis can precede the onset of KOA. When asked \"Who is the chicken and who is the egg\", a recent study suggested that an increased risk of periodontitis and KOA were observed for patients with either disease [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This association would be associated with the severity of KOA and/or periodontitis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our study, this link with the severity of OA was only found for severe structural damage and not for pain and disability. This discrepancy is also found in certain studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. We are unable to say whether the radio-clinical dissociation in OA could explain this discrepancy. Nevertheless, previous studies globally suggested that periodontitis is associated with the presence of KOA [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], structural severity of KOA leading to prosthetic surgery [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and type 2 diabetes might be a booster of this relationship [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, a two-sample bidirectional Mendelian randomization analysis using publicly released genome-wide association studies (GWAS) statistics did not demonstrate a causal effect of genetically predicted periodontitis and OA, neither did genetically predicted OA on periodontitis [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Nevertheless, apart from the complement pathway, some other pathways could explain the link between periodontitis and KOA. In a mouse model of OA, greater alveolar bone loss was found in cases of periodontitis [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Also, the same bacterial DNA has been found in the periodontal tissue and synovial fluid of patients with OA [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These suggest that bacterial pathogens causing periodontitis might spread to joints through the bloodstream [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and/or bacterial lipopolysaccharides may increase the risk of individuals developing OA [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These findings support the hypothesis that periodontal pathogens could modify the homeostasis of the joint via a direct effect or a cross-reaction with immunologic tolerance of the bacterial biofilm acting on the cartilage and surrounding tissues. In addition, an Omics-based study has identified gene signatures as common significant biomarkers/targets associated with the molecular mechanism of periodontitis, RA and OA [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Otherwise, promising results already suggest the efficacy of certain symptomatic slow-acting drugs for OA in periodontitis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Conversely, introducing a conditioned medium from periodontal ligament-derived stem cells to osteoarthritic joints could be a potential treatment to prevent OA progression by inhibiting inflammation [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Further studies are needed to appreciate if specific treatment of periodontitis or KOA might be effective for patients with either disease. Also, it will be interesting to know whether improving oral health-related behaviors and access to oral health care could be a solution to reduce the prevalence and severity of both periodontitis and KOA. In the meantime, clinicians treating OA should consider the need for dental care for their patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has three main limitations. Using a cross-sectional study design does not allow us to demonstrate a cause-and-effect relationship between periodontitis and OA and evidence for the bidirectional nature of the association, as would have been possible with a prospective cohort study. Performing bacteriological samples from the knee and oral cavity would have provided further evidence in favor of this link. However, for ethical reasons, samples from the knee can be taken globally during surgery, which was not the case for the patients in our study. The non-randomized sampling technique related to the hospital-based design is a major selection bias. Then, the findings of this study cannot be generalized without caution.\u003c/p\u003e \u003cp\u003eIn conclusion, we found that severe periodontitis is significantly associated with KOA and poor oral hygiene. We are waiting for studies to indisputably demonstrate the link between KOA and periodontitis. Until then, there is a need to improve oral health-related behaviors and access to oral health care for patients with KOA.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAP: American Association of Periodontology\u003c/p\u003e\n\u003cp\u003eACR: American Coll\u0026egrave;ge of Rheumatology\u003c/p\u003e\n\u003cp\u003eADA: American Diabetes Association\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003eCAL: Loss of Clinical Attachment\u003c/p\u003e\n\u003cp\u003eDPSI: Dutch Periodontal Screening Index\u003c/p\u003e\n\u003cp\u003eEFP: European Federation of Periodontology\u003c/p\u003e\n\u003cp\u003eHBP: High Blood Pressure\u003c/p\u003e\n\u003cp\u003eK\u0026amp;L: Kellgren and Lawrence\u003c/p\u003e\n\u003cp\u003eKOA: Knee Osteoarthritis\u003c/p\u003e\n\u003cp\u003eMOH: Motivation for Oral Hygiene\u003c/p\u003e\n\u003cp\u003eNICE: National Institute for Health and Care Excellence\u003c/p\u003e\n\u003cp\u003ePLHIV: Patient Living with HIV\u003c/p\u003e\n\u003cp\u003ePP: Periodontal Pocket\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eVAS: Visual Analog Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e We have obtained an ethical clearance from the Ethical Regional Committee for the Littoral Region (n\u0026deg; 2023/6/CE/CRERSHLITTORAL) and research authorization from the institutional board of the Douala General Hospital (n\u0026deg;033/AR/MINSANTE/HGD/DM/02/23). We conducted this study in strict compliance with the fundamental principles of scientific research in medicine. Patients were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e : Not Applicable \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and document availability:\u003c/strong\u003e The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests:\u003c/strong\u003e The authors state they have no competing interests. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding was received for this study. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e: Design and design: HSCT, FKL, SRSN, CMT, JA. Data collection: HSCT, FKL, SRSN, CDN, LEEB. Data analysis and interpretation: CDN, HSCT, FKL, SRSN. Manuscript writing: HSCT, FKL, SRSN, CMT, CDN, FAT, SPC. Manuscript revision: HSCT, FBS, FKL, SRSN, CMT, LEEB, SPC. All authors read and approve the final version for publication. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: \u003c/p\u003e\n\u003cp\u003eAn earlier version of this manuscript was presented as an abstract entitled \u003cem\u003ePr\u0026eacute;valence et d\u0026eacute;terminants des parodontites chez les sujets suivis pour gonarthrose au Cameroun\u003c/em\u003e at The French Congress of Rheumatology (December 2023, Paris, France). according to the following link: https://www.sciencedirect.com/science/article/abs/pii/S1169833023007676; doi: 10.1016/j.rhum.2023.10.394\u003c/p\u003e\n\u003cp\u003eWe thank the participants and all the Rheumatology and Stomatology Units of the Douala General Hospital staff and its Director Pr Henri Nname Luma. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor informations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026middot;\u003c/strong\u003eHerna Stella CHIMY TCHOUNCHUI : [email protected] ; ORCID: 0009-0006-3719-1754\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Fernando KEMTA LEKPA: [email protected] ;ORCID: 0000-0001-7592-5049\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Sylvain Raoul SIMENI NJONNOU: [email protected] ; ORCID: 0000-0002-5050-566X\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Clarisse MAPA-TASSOU : [email protected] ; ORCID : 0000-0002-0709-1449\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Christian DEUBE NGAKO: [email protected] , ORCID : 0009-0004-4667-6396\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Faustin ATEMKENG TSATEDEM : [email protected] , ORCID : 0000-0002-3530-2637\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; F\u0026eacute;licit\u0026eacute; SOH MALEU MBAH: [email protected] , ORCID: 0009-0006-7383-2942\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Lawrence ESSAMA ENO BELINGA: [email protected] , ORCID : 0000-0003-2204-6686\u003c/p\u003e\n\n\u003cp\u003e\u0026middot; Francine SAME BEBEY: [email protected] , ORCID: 0000-0001-7882-354X\u003c/p\u003e\n\n\n\u003cp\u003e\u0026middot;Jerome ATEUDJIEU : [email protected] , ORCID : 0000-0002-2156-1160 \u003c/p\u003e\n\n\n\u003cp\u003e\u0026middot; Sim\u0026eacute;on Pierre CHOUKEM : [email protected] , ORCID : 0000-0003-1399-5513\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHunter DJ, Bierma-Zeinstra S. 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PMID: 32011029. \u003c/li\u003e\n\u003cli\u003eKassebaum NJ, Bernab\u0026eacute; E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045-53. doi: 10.1177/0022034514552491. Epub 2014 Sep 26. PMID: 25261053; PMCID: PMC4293771.\u003c/li\u003e\n\u003cli\u003eRodr\u0026iacute;guez-Lozano B, Gonz\u0026aacute;lez-Febles J, Garnier-Rodr\u0026iacute;guez JL, Dadlani S, Bustabad-Reyes S, Sanz M, S\u0026aacute;nchez-Alonso F, S\u0026aacute;nchez-Piedra C, Gonz\u0026aacute;lez-D\u0026aacute;vila E, D\u0026iacute;az-Gonz\u0026aacute;lez F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019;21(1):27. doi: 10.1186/s13075-019-1808-z. PMID: 30658685; PMCID: PMC6339403.\u003c/li\u003e\n\u003cli\u003eDisale PR, Zope SA, Suragimath G, Varma AS, Pisal A. Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis. J Family Med Prim Care. 2020;9(6):2919-2925. doi: 10.4103/jfmpc.jfmpc_398_20. PMID: 32984149; PMCID: PMC7491801.\u003c/li\u003e\n\u003cli\u003eCoburn BW, Sayles HR, Payne JB, Redman RS, Markt JC, Beatty MW, Griffiths GR, McGowan DJ, Mikuls TR. Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis. J Periodontol. 2015;86(1):16-26. doi: 10.1902/jop.2014.140339. PMID: 25269524. \u003c/li\u003e\n\u003cli\u003eYin KJ, Huang JX, Wang P, Yang XK, Tao SS, Li HM, Ni J, Pan HF. No Genetic Causal Association Between Periodontitis and Arthritis: A Bidirectional Two-Sample Mendelian Randomization Analysis. Front Immunol. 2022;13:808832. doi: 10.3389/fimmu.2022.808832. PMID: 35154127; PMCID: PMC8825874. \u003c/li\u003e\n\u003cli\u003eAl Bayaty FH, Mahmod SA, Jamil Al-Obaidi MM, Emad Ibrahim O, Dahir A, Adam FA, Albandar JM. Effect of osteoarthritis on alveolar bone loss in experimental periodontitis in rats. J Periodontal Res. 2023;58(1):22-28. doi: 10.1111/jre.13064. Epub 2022 Nov 2. PMID: 36321414.\u003c/li\u003e\n\u003cli\u003eT\u0026eacute;moin S, Chakaki A, Askari A, El-Halaby A, Fitzgerald S, Marcus RE, Han YW, Bissada NF. Identification of oral bacterial DNA in synovial fluid of patients with arthritis with native and failed prosthetic joints. J Clin Rheumatol. 2012;18(3):117-21. doi: 10.1097/RHU.0b013e3182500c95. PMID: 22426587; PMCID: PMC3888235.\u003c/li\u003e\n\u003cli\u003eHoy SR, Vucetich JA, Vucetich LM, Hindelang M, Huebner JL, Kraus VB, Peterson RO. Links between three chronic and age-related diseases, osteoarthritis, periodontitis, and osteoporosis, in a wild mammal (moose) population. Osteoarthritis Cartilage. 2023:S1063-4584(23)00994-9. doi: 10.1016/j.joca.2023.11.016. Epub ahead of print. PMID: 38043856. \u003c/li\u003e\n\u003cli\u003eSao P, Chand Y, Al-Keridis LA, Saeed M, Alshammari N, Singh S. Classifying Integrated Signature Molecules in Macrophages of Rheumatoid Arthritis, Osteoarthritis, and Periodontal Disease: An Omics-Based Study. Curr Issues Mol Biol. 2022;44(8):3496-3517. doi: 10.3390/cimb44080241. PMID: 36005137; PMCID: PMC9406916. \u003c/li\u003e\n\u003cli\u003eSilva RCL, Sasso-Cerri E, Cerri PS. Diacerein-induced interleukin-1\u0026beta; deficiency reduces the inflammatory infiltrate and immunoexpression of matrix metalloproteinase-8 in periodontitis in rat molars. J Periodontol. 2022;93(10):1540-1552. doi: 10.1002/JPER.21-0375. Epub 2022 Mar 28. PMID: 35184279. \u003c/li\u003e\n\u003cli\u003eHuang CY, Vesvoranan O, Yin X, Montoya A, Londono V, Sawatari Y, Garcia-Godoy F. Anti-Inflammatory Effects of Conditioned Medium of Periodontal Ligament-Derived Stem Cells on Chondrocytes, Synoviocytes, and Meniscus Cells. Stem Cells Dev. 2021;30(10):537-547. doi: 10.1089/scd.2021.0010. Epub 2021 Apr 23. PMID: 33757298.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knee osteoarthritis, periodontitis, prevalence, determinants","lastPublishedDoi":"10.21203/rs.3.rs-5943034/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5943034/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOsteoarthritis (OA) is a slowly evolving multifactorial disorder that affects joints, particularly the knee. Periodontitis is an infection of the tissues supporting the teeth, leading to significant tooth loss. Recent studies suggest an association between Knee OA (KOA) and periodontitis, with the prevalence of periodontitis increasing with the severity of KOA. We aimed to determine the prevalence and distribution of periodontitis and the association between the severity of KOA and periodontitis in subjects living with KOA.\u003c/p\u003e\u003ch2\u003ePatients and methods:\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in an outpatient clinic at the Rheumatology unit of the Douala General Hospital between October 2022 and June 2023. Data were collected using a questionnaire, an endo-buccal examination grid, radiological images and medical records. A multivariate analysis using logistic regression was performed, including the relevant variables in the bivariate analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e We included 253 participants (201 women) with a median age of 63 years [54\u0026ndash;70]. The mean VAS was 52.7\u0026thinsp;\u0026plusmn;\u0026thinsp;27.9 mm. The mean Lequesne index was 12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03. Kellgren and Lawrence (K\u0026amp;L) grade 2 was predominant (61.7%), as was tricompartimental KOA (85.4%). The prevalence of periodontitis was 62.5%. Periodontitis was significantly associated with radiological K\u0026amp;L grade 4 (OR: 5.39 [1.27\u0026ndash;28.98]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03), poor oral hygiene (OR: 34 [7.46277.71]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), visits to the dentist [in case of problems] (OR: 8.54 [3.09\u0026ndash;28.58]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and brushing time (OR: 21.93 [5.66-123.24]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePeriodontitis is common in patients with KOA in Cameroon and is associated with the severity of KOA and poor oral hygiene.\u003c/p\u003e","manuscriptTitle":"Prevalence and determinants of periodontitis among a population with knee osteoarthritis at the Douala General Hospital (Littoral, Cameroon)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-10 10:45:29","doi":"10.21203/rs.3.rs-5943034/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9212bfca-588d-4fae-89f1-6e56205ee1a1","owner":[],"postedDate":"February 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-20T12:08:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-10 10:45:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5943034","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5943034","identity":"rs-5943034","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}