Clinical analysis of osteonecrosis of the jaw in patients with rheumatoid arthritis: risk factors and oral health implications.

INTRODUCTION/

OBJECTIVES

Osteonecrosis of the jaw (ONJ) is a rare but serious complication in patients with rheumatoid arthritis (RA), and its risk factors remain unclear. This study aimed to clarify the clinical characteristics and risk factors for ONJ in patients with RA.

METHODS

We retrospectively analyzed 35 patients with RA who developed ONJ against 276 control patients with RA who received collaborative medical-dental care but did not develop ONJ. Group comparisons were performed using Mann-Whitney U and Fisher's exact tests; logistic regression was performed to determine the risk factors (significance set at p < 0.05).

RESULTS

Univariate analysis revealed that the ONJ group exhibited a higher prevalence of rheumatoid factor positivity (p = 0.021), advanced RA (Steinbrocker stage III-IV; p < 0.0001), osteoporosis (p < 0.0001), low body mass index (< 18.5; p = 0.041), dental infections (p = 0.011), and regular use of nonsteroidal anti-inflammatory drugs (p = 0.004). The use of bone resorption inhibitors was also higher in the ONJ group (p < 0.0001), particularly for treatment rather than prevention (p = 0.020). Multivariate analysis identified osteoporosis (OR 7.82, 95% CI 7.21-8.48, p < 0.001), dental infection (OR 2.25, 95% CI 2.07-2.45, p < 0.001), and advanced stage of RA (OR 4.10, 95% CI 3.68-4.56, p < 0.001) as independent risk factors for ONJ.

CONCLUSIONS

ONJ in patients with RA arises from synergistic effects of osteoporosis, advanced joint destruction, and dental infection. Clinicians should focus on identifying high-risk patients based on RA severity (Steinbrocker stage III-IV) and managing modifiable factors through close medical-dental collaboration to prevent ONJ. Key Points • This retrospective study compared 35 patients with rheumatoid arthritis (RA) who developed osteonecrosis of the jaw (ONJ) with 276 patients with RA who received dental treatment but did not develop ONJ. • Osteoporosis, advanced joint destruction, and dental infection were identified as independent risk factors for ONJ in patients with RA. • Differences in the nutritional and disease profiles were observed: hypoalbuminemia was more frequent in the control group, whereas a low body mass index was more common in the ONJ group. • Collaboration between rheumatologists and dental professionals is crucial for preventing ONJ, maintaining oral function, and supporting the overall health of older adults with RA.