Periodontal Health and Oral Microbiota in Patients with Rheumatoid Arthritis

Abstract

This study aimed to investigate the periodontal health of patients with established rheumatoid arthritis (RA) in relation to oral microbiota, systemic and oral inflammatory mediators, and RA disease activity. Forty patients underwent full-mouth dental/periodontal and rheumatological examination, including collection of blood, saliva, gingival crevicular fluid (GCF) and subgingival plaque. Composition of plaque and saliva microbiota were analysed using 16S rRNA sequencing and levels of inflammatory mediators by multiplex-immunoassay. The majority of the patients (75%) had moderate or severe periodontitis and the rest had no/mild periodontitis. Anti-citrullinated protein antibody (ACPA) positivity was significantly more frequent in the moderate/severe periodontitis (86%) compared to the no/mild group (50%). No significance between groups was observed for RA disease duration or activity, or type of medication. Levels of sCD30/TNFRSF8, IFN-α2, IL-19, IL-26, MMP-1, gp130/sIL-6Rß, and sTNF-R1 were significantly higher in serum or GCF, and April/TNFSF13 was significantly higher in serum and saliva samples in moderate/severe periodontitis. The microbial composition in plaque also differed significantly between the two groups. In conclusion, the majority of RA patients had moderate/severe periodontitis and that this severe form of the disease was significantly associated with ACPA positivity, an altered subgingival microbial profile, and increased levels of systemic and oral inflammatory mediators.

Cytokines in gingivocrevicular fluid of rheumatoid arthritis patients: A review of the literature

“…To determine potential causality between periodontitis and RA, presence and production of RA‐associated antibodies in the periodontium should be investigated, preferably with assessment of the microbial composition of the dental biofilm. In this respect, Eriksson et al, () very recently showed that most RA patients with moderate or severe periodontitis were seropositive for ACPA (86%) as well as that these patients had a subgingival microbial profile that differed from RA patients with no or mild periodontitis and had higher levels of oral and systemic inflammatory mediators.…”

Rheumatoid Arthritis-Associated Mechanisms of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans

“…Different approaches have been used to address a potential association between P. gingivalis and RA, many of which have shown inconsistent or inconclusive results. These include: (1) bacterial detection in gingival tissue, subgingival plaque and/or gingival crevicular fluid (GCF) either by staining using anti- P. gingivalis antibodies, bacterial culture, and/or DNA amplification (PCR) [101,102,103,104,105,106,107]; (2) metagenomic sequencing in saliva and subgingival plaque, which surveys complex microbial communities [103,106,108,109,110,111,112]; and (3) measuring antibodies to P. gingivalis in serum [101,113,114,115,116,117,118,119,120,121,122,123,124,125], which in contrast to the other assays that detect the existing bacteria in the mouth, it is an indirect test that determines past or present exposure to P. gingivalis .…”

Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues

“…Interestingly, associations between bacterial measures and prediabetes are consistently stronger than those between periodontitis and prediabetes. Furthermore, there is accumulating evidence on the role of P. gingivalis in rheumatoid arthritis [37,38]. A prospective study on the association between pancreatic cancer and the oral microbiome revealed that the carriage of P. gingivalis and A. actinomycetemcomitans is a subsequent risk for this highly lethal cancer type [39].…”