Session Information
Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose
Emerging evidence suggests that periodontitis and periodontal pathogens, such as Porphyromonas gingivalis (Pg), may be an environmental trigger for rheumatoid arthritis (RA). We found that antibodies to Pg are increased in a subset of untreated early RA patients and correlate with anti-citrullinated protein antibodies (ACPA). As a next step, we are evaluating periodontal disease in our RA patients. We report here findings of periodontitis in the first 23 patients who have completed formal dental examinations.
Methods
23 RA patients, 15 with new-onset disease and 8 with chronic RA, completed standardized dental examination performed by a single periodontist. All patients met the 2010 ACR/EULAR criteria for RA. 20 age- and gender-matched healthy subjects without periodontitis or RA were also enrolled. Dental parameters for assessment of periodontitis per the Centers for Disease Control criteria included pocket depth (PD), gingival margin, bleeding on probing (BOP) measured at 6 sites per tooth, and clinical attachment loss (CAL). Serum Pg IgG antibodies were measured by ELISA. The dental examiner was blinded to joint and laboratory findings.
Results
Typical of RA cohorts, the patients were predominantly female (87%) with median age of 48. The majority (61%) was seropositive for ACPA, 43% were positive for rheumatoid factor (RF), and they had a range of disease activity. None were current smokers, but 10 previously smoked. All but one patient received routine dental care with cleanings every 6 months.
Of the 23 patients, 10 (43%) had gingivitis, a precursor of periodontitis, 9 (39%) had periodontitis, and only 4 patients (17%) had healthy periodontal tissue. Compared with the 20 healthy subjects, the 23 RA patients had significantly increased pocket depth (P<0.000001), CAL (P=0.001), and BOP (P=0.0001). There were no differences in dental parameters between former vs. never smokers.
In the 23 patients, ACPA levels correlated directly with CAL (P=0.03), the most significant determinant of periodontal disease, and with BOP (P=0.05). In addition, dental parameters correlated with ESR values (P=0.04) and tended to correlate with RF (P≤0.09) and disease activity (DAS-28-ESR, swollen and tender joint counts) (P≤0.1).
Six of the 23 patients (26%) had elevated serum Pg IgG antibodies. All 6 patients with positive Pg antibodies had periodontitis, while no patient with gingivitis or normal periodontal tissue had elevated Pg antibodies (P<0.001). Finally, Pg antibodies strongly correlated with all dental parameters including pocket depth (P<0.0001), BOP (P=0.003), and CAL (P=0.02).
Conclusion
Most of our patients with early and chronic RA had gingivitis or periodontitis on formal examination, although they received regular dental care. Parameters of periodontitis correlated significantly with ACPA, supporting a role for periodontal disease in RA pathogenesis. As Pg antibodies correlate strongly with periodontitis, these may be useful biomarkers in screening for periodontal disease in RA patients. Finally, periodontitis tended to correlate with RA disease activity, supporting a role for periodontal disease evaluation and treatment in a subset of RA patients.
Disclosure:
S. L. Arvikar,
Arthritis Foundation,
2;
H. Hasturk,
NIH,
2;
M. B. Bolster,
Eli Lilly and Company,
2;
D. S. Collier,
None;
A. Kantarci,
NIH,
2;
A. C. Steere,
ACR, NIH, Foundation,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/parameters-of-periodontitis-correlate-with-anti-citrullinated-protein-antibodies-and-p-gingivalis-antibody-titers-in-patients-with-early-or-chronic-rheumatoid-arthritis/