Background/Purpose: Early RA (eRA) patients have a significant incidence of periodontal inflammation and overweight/obesity. A similar degree of disease activity, functional disability and health-related quality of life has been observed in comparison to established disease. Based on the evidence with regard to the relationship between obesity and periodontitis, these two conditions could be linked because of the production of adipokines. Therefore, the aim of this study is to evaluate the association of adipokines with of rheumatologic parameters, body mass index (BMI) and periodontitis in eRA and first-degree relatives of RA (FDR).

Methods: A cross-sectional study was conducted including 62 eRA patients (fulfilling the 2020 ACR/EULAR criteria), 124 FDR (genetic risk for developing RA according to EULAR recommendations) and 186 healthy controls matched by age and gender for each group. A complete medical history and joint count was performed. Adiponectin, adipsin, resistin and vaspin levels measured using Luminex technology, IL6 and leptin were measured by ELISA and Porphyromonas gingivalis by qPCR.  Serum markers such as RF, ACPA, ESR and CRP were evaluated. Disease activity and radiographic assessment were evaluated using DAS-28 CRP, DAS-28 ESR, SDAI, RAPID3 and SENS score (hands/feet). An association analysis was made to evaluate the relationship between adipokines levels, rheumatologic parameters and P.gingivalis using X2, Fisher’s Exact or U Mann Whitney test. A logistic regression model was performed to confirm associations.

Results: In patients with eRA, 35.8% were ACPA plus P. gingivalis positive, whereas 57.9% had high levels of adipsin. In total, 53.8% had both P. gingivalis plus high leptin levels, and 37.7% had both P. gingivalis plus high adipsin levels. High disease activity (DAS28ESR >3.2) was observed in 63.6%.  Patients ACPA plus P. gingivalis positives, had high leptin levels (68.4%), and high disease activity (DAS28ESR >3.2) (62.53%). The following associations were found: high leptin levels (OR, 8.22; 95% CI, 2.7–24.5; p = 0.001), high adipsin levels (OR, 3.06; 95% CI, 1.0–8.9; p = 0.041) and DAS-28 ESR >3.2 (OR, 2.59; 95% CI, 1.4–4.5; p = 0.001).

In the FDR group, the P. gingivalis presence was associated to lower levels of adipsin (p = 0.002), resistin (p = 0.001), adiponectin (p = 0.003) and a statistical tendency to high levels of leptin (p = 0.060). Tender joints were related to low levels of adipsin (p = 0.019), and high levels of resistin (p = 0.040) and leptin (p=0.040). High levels of leptin were associated with radiographic damage SENS in hands (p = 0.037), total SENS (p=0.026), narrowing joint space in feet (p=0.020) and ACPA positivity (p=0.038).

Conclusion: High levels of leptin and adipsin were associated with clinical disease activity in patients with early RA and periodontal infection, presented simultaneously. In the genetic risk group (FDR) the adipokine profile was associated with the presence of P. gingivalis and joint parameters. This factor may modulate the inflammatory environment and increase the risk of developing RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-influence-of-adipokine-profile-and-periodontal-infection-in-early-stages-of-rheumatoid-arthritis-and-first-degree-relatives/