Background/Purpose:

Juvenile idiopathic arthritis (JIA) and periodontal disease (PD) are both diseases of inflammation that can result in bone loss when the inflammatory process is prolonged. In periodontal disease redness and swelling to gums represents infection of bacteria such as Porphyromonas gingivalis (Pg). Hitchon (2010) linked anti-p.gingivalis antibodies and anti- cyclic citrullinated peptide (CCP) antibodies in adult patients with rheumatoid arthritis. CCP antibodies are linked with erosive joint disease. In 2016 Lange investigated antibody responses to oral pathogens of children with JIA, concluding that children with CCP- positive JIA have higher antibody titers to p.gingivalis. The purpose of this study is to determine the presence of the bacteria (Pg) in children with JIA who are positive for rheumatoid factor (RF) or CCP.

Methods:

A convenience sample of 12 children ages 10-21 with a diagnosis of JIA and either RF positive or CCP positive was selected from a hospital based rheumatology clinic. A full exam, including an oral exam was completed to assess for JIA and PD disease activity. During the exam a saliva sample was collected to identify the presence of common pathogens associated with gum disease and increased risk of systemic disease. Genomic DNA was extracted from the saliva sample and tested for bacteria associated with periodontal disease. The bacteria were tested by PCR amplification followed by fluorescent endpoint detection of sample bacterial concentrations. Pathogenic bacteria were reported as low, moderate or high risk for association with periodontal disease. Differences in the bacterial profile were compared to an age and gender matched control group with periodontal disease. Fisher’s exact test and Wilcoxon test were used to compare the groups.

Results:

Upon physical examination 7 of 12 children (58%) examined showed signs of localized oral inflammation to one or more teeth, none of the 12 had generalized oral inflammation. Only 2 of 12 children (17%) had presence of Pg: neither had bleeding with brushing or flossing and one exhibited localized gum redness. Exploratory analysis of common pathogens associated with periodontal disease: JIA status was not associated with Pg, Fisher’s Exact Test p = 0.68. Calculated Pg bacterial load was not different by JIA status, Wilcoxon Rank Sum Test p = 0.63. Infection status was associated with JIA status, Fisher’s Exact Test p < 0.01. 4 of 12 children (33%) exhibited presence of high risk bacteria: Pg, Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf) and Treponema denticola (Td). There was no significant difference in high risk bacterial counts by JIA status (p = 0.63, 0.30, 0.35 & 0.61 respectively). The results of this study were limited by sample size.

Conclusion:

Children with CCP-positive or RF positive JIA have similar bacterial profiles as children with periodontal disease placing them at risk for development of periodontal disease. This reinforces the need for inclusion of oral health exam within the JIA population. Further studies with larger sample sizes are needed to understand the association between oral pathogens and the inflammatory process.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pathogens-in-the-inflammatory-process-of-periodontal-disease-and-juvenile-idiopathic-arthritis/