Background/Purpose: In rheumatoid arthritis (RA), autoimmunity towards citrullinated peptides driven the hypothesis, in which periodontal disease (PD) is strongly related to the pathogenesis. Given the genetic association, first degree relatives (FDR) of RA-patients are considered a high-risk population to develop RA. The objective is to assess the evolution of clinical disease activity and radiographic progression associated with PD in early RA (eRA) and FDR at one-year follow-up

Methods: Patients fulfilling 2010 ACR/EULAR classification criteria and disease duration less than 2 years, additionally, relatives of patients with RA having a first degree of consanguinity were included. The following parameters were assessed: disease activity (DAS-28, SDAI), radiographic assessment of hands/feet (SENS score) for eRA, joint count assessment, serological bio-markers and a clinical periodontal evaluation was performed. Data was collected at baseline and one-year follow-up.  The statistical analyses were done using the chi-square test. Ethical committee approval was obtained

Results: In total 46 eRA-patients and 83 FDR-individuals were included. In eRA the mean age was (47.8 ± 11.7 years). The increasing disease activity by DAS-28 was associated with the presence of RF (p = 0.020), ACPA(p = 0.008), tender joints (p = 0.001), swollen joints (p = 0.016) and SDAI (p = 0.005). In all patients increasing their disease activity, the presence of P. gingivalis bacteria in sub-gingival plaque was observed (p = 0.016). With regard to periodontal condition, the incremental disease activity was associated with the presence of periodontal pockets (4-5 mm) (p = 0.018) and the bleeding at probing (p = 0.046). The change in total SENS score was observed in 55 % of progressors, associated with the presence of ACPA (p = 0.009). Additionally, in 100% of eRA patients who had radiological progression, a diagnosis of PD was established (p = 0.003). Moreover, in those who had radiological progression, the average loss of tooth insertion increased more than three times, (p = 0.001) and more than 50% of the sites evaluated had insertion loss ≥3 mm (p = 0.014)

In the FDR group (76% women), the increasing number of swollen joints at one-year follow-up was associated with active smoking (p=0.050), overweight (p=0.026), obesity (p=0.003) and fewer teeth (p=0.041). The periodontal pockets were associated with an increase of 30% in CRP levels (p=0.05), and the number of erosions (hands/feet) were associated with higher ESR levels (p=0.004). The increase in foot radiographic score was associated with higher levels of CRP (p=0.039). Finally, 2 out of 83 FDR were diagnosed with RA at one year of follow-up, for an accumulated incidence of 2.4 in individuals having genetic-risk. These 2 individuals (women) has PD and were ACPA positive.  

Conclusion: In patients with eRA, disease activity and radiographic progression were directly related to periodontal involvement and ACPA levels at one-year follow-up. In FDR individuals the swollen joints and positivity of acute-phase reactants were associated to overweight/obesity and periodontal parameters. The incidence of RA in FDR is significant in this population

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-to-clinical-and-radiographic-disease-progression-in-patients-with-early-ra-and-first-degree-relatives-a-1-year-follow-up/