Background/Purpose:  Periodontitis and rheumatoid arthritis (RA) are chronic destructive inflammatory diseases with significant worldwide prevalence. They are characterized by inflammatory lesions adjacent to bone destruction involving connective tissue and bone. Dickkopf-1 (DKK-1) is a major regulator of bone mass; however, their involvement in local bone resorption is largely unknown. The aim of this study was to assess the utility of DKK-1 levels in gingival crevicular fluid (GCF) and serum as a potential predictor of bone loss in periodontal disease and/or early RA

Methods:  Cross-sectional study. Samples of serum and GCF (including 240 interproximal periodontal sites) were obtained from 24 patients with early RA. Adult patients were classified according to the 2010 ACR-EULAR criteria. The periodontal diagnosis was stablished according to the American Association of Periodontology and the Center for Disease Control and Prevention. Radiographs from hands and feet were taken and evaluated using the Sharp-van der Heijde score (SvH) as well as dental cone-beam computed tomography (CBCT) to evaluated interproximal sites. Serum DKK1 levels were determined by ELISA. An association analysis was made to evaluate the relationship between Dkk1 levels and periodontal, rheumatologic or radiographic scores using X2 test, and a multinomial or basic logistic regression model was performed to confirm this associations. The comparisons for Dkk1 levels and bone loss by tomography according to rheumatic scores were made by Kruskal Wallis and U Mann-Whitney tests. This study was approved by the Ethics Committee of the Institution

Results:  Mean age 50±12.0 years, Bone Mass Index 25.3±3.6, C-reactive protein 4.6±20.7, ESR 15±21.7, DAS28-ESR 4.04±1.4, SDAI 17.5±22.28, HAQ 1.3±2.4, APCA IgG/IgA 130.5±7.8, RF 33.2±54.6, SvH 50.4% without the presence of erosion or decreased joint space, 66.6% periodontal diagnosis with moderate severity of 33.3% with 59.6% bone loss in interproximal sites (CBCT). GCF DKK1 levels showed a relationship with periodontal bone loss (p = 0.011). DKK1 levels were associated with both periodontal diagnosis and periodontal severity (p = 0.07 and 0.011 respectively). That condition was maintained for periodontal severity (OR: 2.58 IC_95% 2.28 – 7.28 p= 0.001). 47.5% of GCF DKK1 high levels had also increased DKK1 serum levels (p = 0.022 by X2; OR: 2,41 IC_95% 1.14 – 5.09 p= 0.021). It was observed associations between GCF-DKK1 levels and the activity score DAS28ESR (p = 0.000), HAQ (p = 0.000; RRR: 1,96 IC_95% 1.04 – 4.21 p= 0.035), RAPID 3 (p = 0.000) and presence of painful joints (p = 0.04). Despite that, It was not observed associations between GCF-DKK1 levels and SvH. However, feet bone erosion evaluated by SvH and juxta-articular osteopenia were associated with high levels of serum DKK-1 (p=0.009 and 0.001 respectively), showing serum levels up to 7 folds increased. Serum DKK1 levels also showed associations with SDAI (p=0.006; RRR: 2,38 IC_95%1.03 – 5.52 p= 0.043), RAPID (p=0.000) and RF (0.018).

Conclusion:  The DKK1 can be considered as a potential biomarker for bone resorption in joint and periodontal disease in patients with early rheumatoid arthritis. Seror R et al. Sci Rep. 2016; 20:18421

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/could-increase-levels-of-dickkopf-1-protein-be-considered-as-a-potential-biomarker-for-bone-resorption-in-joint-and-periodontal-disease-in-patients-with-early-rheumatoid-arthritis/