Background/Purpose: Positivity of anti-citrullinated peptides antibodies (ACPA) indicates severity in Rheumatoid Arthritis (RA). There is evidence for chronic periodontitis (PD) in RA autoimmune response by periodontopathogenic bacteria, through protein citrullination. Thus, our objectives were: 1.To determine whether there is an association between PD and its severity with ACPA(+).2.To assess relationship between PD and ACPA titres.3.To identify association between certain periodontal parameters and ACPA titres and their possible cut-off points.

Methods: Cross-sectional study RA patients ≥18 yo with ≥4 teeth, no tooth cleaning, antibiotic intake 6 months before. Comorbidities, demographics, DAS-28(ESR), DAS-28(CRP)and SDAI were taken. Serum ACPA detection: Ab IgG against CCP2 (ELISA) Immunoscan CCPlus®test kit Euro Diagnostica: positive≥25 U/mL; ACPA titres stratification: Low (25–75), moderate (76–300) and high (>300). Periodontal parameters: plaque index (PI), bleeding on probing (Bop), probing pocket depth, clinical attachment level (CAL). CAL loss was categorized according to European Workshop 2005 (Tonetti):T level0 (absence), TL1 (mild), TL2 (severe). Statistical analysis: t-student, Kruskal Wallis, Chi- squared tests.

Results:

187 RA patients included (table 1), ACPA determined in 168 patients: 67.86% (+) with similar titres distribution: low 18%, moderate 26%, high 23%. PD:182 patients (97.3%): TL1 52.4%, TL2 44.9%. Although prevalence of severe PD/ACPA(+) was higher compared to PD/ACPA(-) (69.2% vs 30.7%), there was no association between PD and ACPA positivity/titres. Regarding the association with periodontal parameters, there was tendency of association between ACPA(+) and number of periodontal pockets ≥5mm, adjusted OR 1.02 (95% CI 0.9–1.04). However, there was a gradient effect, where number of pockets ≥ 5mm increased as ACPA titles increased, which was significant for high ACPA titres (p≤0.05,OR 1.03 95% CI 1.0–1.05). Moreover, RA patients who have 15 pockets ≥ 5mm showed 1.789-fold risk of having high ACPA titres (95% CI 0.928-3.448, p 0.082). In the lineal regression analysis, a statistically significant increase of 6.946 U/mL (95% CI 2.271-11.621) was found for each pocket ≥5mm in RA patients with moderate-high disease activity (p 0.004, adjusted by age, gender and smoking). When ACPA(+) was related to %PI and BoP, a strong association was observed for PI, OR 10.32 (p<0,026), and only a tendency for BoP (p<0.062). A risk for ACPA(+) was detected with cut-off points of 8%(OR 2.19) PI and 65% BoP (OR 2.45).

Conclusion: 1.Despite higher prevalence of severe PD in ACPA(+) patients, we found no association between the presence of PD and ACPA positivity nor with serum titres. 2. On analysis of ACPA titres in relation to the severity of the periodontal parameters, there was a “gradient” risk, where number of pockets ≥5mm increased as ACPA titres increased, which was significant for high ACPA titres.3. There was a lineal correlation between ACPA titres and number of pockets ≥5mm.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-anti-citrullinated-protein-antibody-levels-associated-with-periodontal-disease-in-rheumatoid-arthritis/