Background/Purpose: Although several studies have suggested the association between periodontitis, infection by Porphyromona gingivalisand Rheumatoid Arthritis disease activity, its relationship with periodontal disease, oral and plasma peptidyl-arginine deiminase (PAD) activity and citrullination of soluble blood proteins still remains poorly known. Objective: To evaluate the relationship between periodontal disease, and clinical disease activity of Rheumatoid Arthritis (RA) patients. Methods: RA patients included fulfilled the ACR/EULAR 2010 criteria, signed an informed consent form and were followed at the rheumatology clinic for one year. Patients were divided into 2 groups according to clinical activity. Patients with secondary Sjögrens disease were excluded. Patients having a DAS28 of less than 3.4 were considered as having low activity and above that number they were grouped as having high activity. Periodontal evaluation and oral and peripheral blood samples were obtained the same day as the clinical evaluation. PAD-activity was performed using a colorimetric assay employing BAEE (Sigma) as substrate and recombinant human PAD4 (Cayman Chem) as positive control. Citrullination was evaluated by Western Blot of immunoprecipitated saliva and blood fibrinogen, employing a polyclonal anti-citrulline antibody (Millipore). Plasma pro-inflammatory cytokines and aCCP levels were evaluated by ELISA. Descriptive statistics were employed to evaluate differences between groups and the Spearman correlation test was used to associate them with clinical parameters. Results: 48 RA patients were divided into 2 groups: 33 presented high activity and 15 low activity; their mean age was 41.2 vs. 43 years of age, respectively, BMI was 26.8 vs. 27.2, and time since onset of disease 8.5±10.9 vs. 5.44±3.8 years, respectively; both groups’ demographic characteristics showed no statistically significant differences. High disease activity patients had a significantly lower index of periodontitis (1.57±1.06; p< 0.02), while low disease activity patients were associated with severe periodontitis (3.0±1.23). Otherwise, high disease activity patients showed a mean decrease of 1.5 DAS28 units after one year of follow-up and treatment, while low disease activity RA patients  showed a  lower therapeutic response (a change of <0.5 DAS28 units). No relationship was seen with PAD activity. Conclusion: High RA disease activity is negatively associated with severe periodontitis, although the same patients showed a higher therapeutic response after one year of follow up, in comparison to low disease activity RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/periodontal-disease-and-clinical-activity-of-rheumatoid-arthritis-patients/