Periodontal pathogens participate in synovitis in patients with rheumatoid arthritis in clinical remission: a retrospective case–control study

Kimura, Yuko; Takeuchi, Tohru; Kimura, Motoshi; Yoshikawa, Ayaka; Hiramatsu, Yuji; Ishida, Takaaki; Makino, Shigeki; Takasugi, Yoshihiro; Hanafusa, Toshiaki

doi:10.1093/rheumatology/kev274

Cited by 12 publications

(21 citation statements)

References 47 publications

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“…These results were in line with available studies . However, clinically, only ESR is not enough to quantify subclinical synovial hypertrophy . Moreover, laboratory tests and physical examinations have only sensitivity, no specificity for synovitis, tenosynovitis, tibiotalar synovitis, bursitis, or enthesopathy .…”

Section: Discussionsupporting

confidence: 87%

Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

Han

Tian

2019

Int J of Rheum Dis

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Objective: Laboratory investigations are invasive methods. Magnetic resonance imaging (MRI) has a small field of view. Ultrasound can be performed at multiple parts of the body. The objective of the study was to find out subclinical synovial hypertrophy in systemic lupus erythematosus patients using gray-scale/power Doppler ultrasonography. Methods: A total of 247 systemic lupus erythematosus (without musculoskeletal involvement) patients from 21 February 2017 to 28 October 2018 were included in the cross-sectional study. Patients were subjected to physical examinations, laboratory tests, and gray-scale/power Doppler ultrasonography examinations. Synovial hypertrophy was confirmed if it was present in at least 4 out of 100 of the examined location sites. MRI examinations were performed for confirmation purposes. Spearman correlation was performed between imaging and laboratory investigations at the 99% confidence level. Results: No correlation was observed for results of synovial hypertrophy between physical examinations/laboratory tests and gray-scale/power Doppler ultrasonography examinations except erythrocyte sedimentation rate (r = 0.354). Cost of laboratory tests (315.47 ± 19.15 ¥/person) for subclinical synovial hypertrophy detection was higher than that of gray-scale/power Doppler ultrasonography examinations (135.47 ± 8.17 ¥/person, P <0.0001, q = 230.87). Results of gray-scale/power Doppler ultrasonography have a correlation with results of MRI (r = 0.34). Conclusion: Only perform gray-scale/power Doppler ultrasonography examinations for regular maintenance of rheumatologic disease in systemic lupus erythematosus patients. K E Y W O R D S bursitis, erythrocyte sedimentation rate, subclinical synovitis, systemic lupus erythematosus, ultrasonography | 1059 HAN ANd TIAN

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Section: Discussionsupporting

confidence: 87%

Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

Han

Tian

2019

Int J of Rheum Dis

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“…It has been speculated that periodontal pathogens drive systemic inflammation or disseminate to affected tissue, thereby promoting localized inflammation. Indeed, increased specific IgG to periodontal pathogens, including Prevotella intermedia and P. gingivalis , has been reported in RA . Furthermore, the presence of DNA from periodontal pathogens has been found in serum and synovial fluid of patients with RA, indicating systemic dissemination of bacteria that directly promote localized synovial inflammation .…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

The immune response to Prevotella bacteria in chronic inflammatory disease

2017

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Summary The microbiota plays a central role in human health and disease by shaping immune development, immune responses and metabolism, and by protecting from invading pathogens. Technical advances that allow comprehensive characterization of microbial communities by genetic sequencing have sparked the hunt for disease‐modulating bacteria. Emerging studies in humans have linked the increased abundance of Prevotella species at mucosal sites to localized and systemic disease, including periodontitis, bacterial vaginosis, rheumatoid arthritis, metabolic disorders and low‐grade systemic inflammation. Intriguingly, Prevotella abundance is reduced within the lung microbiota of patients with asthma and chronic obstructive pulmonary disease. Increased Prevotella abundance is associated with augmented T helper type 17 (Th17) ‐mediated mucosal inflammation, which is in line with the marked capacity of Prevotella in driving Th17 immune responses in vitro. Studies indicate that Prevotella predominantly activate Toll‐like receptor 2, leading to production of Th17‐polarizing cytokines by antigen‐presenting cells, including interleukin‐23 (IL‐23) and IL‐1. Furthermore, Prevotella stimulate epithelial cells to produce IL‐8, IL‐6 and CCL20, which can promote mucosal Th17 immune responses and neutrophil recruitment. Prevotella‐mediated mucosal inflammation leads to systemic dissemination of inflammatory mediators, bacteria and bacterial products, which in turn may affect systemic disease outcomes. Studies in mice support a causal role of Prevotella as colonization experiments promote clinical and inflammatory features of human disease. When compared with strict commensal bacteria, Prevotella exhibit increased inflammatory properties, as demonstrated by augmented release of inflammatory mediators from immune cells and various stromal cells. These findings indicate that some Prevotella strains may be clinically important pathobionts that can participate in human disease by promoting chronic inflammation.

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“…Despite available information, pathobiologic mechanisms connecting RA and periodontitis remain unclear. Many studies solely consider isolated periodontal and/or rheumatologic disease parameters and often have small sample sizes 17–22 . The purpose of the present study is to evaluate periodontal conditions and microbiologic findings as well as their influence on rheumatologic disease parameters in patients with RA.…”

mentioning

confidence: 99%

“…Many studies solely consider isolated periodontal and/or rheumatologic disease parameters and often have small sample sizes. [17][18][19][20][21][22] The purpose of the present study is to evaluate periodontal conditions and microbiologic findings as well as their influence on rheumatologic disease parameters in patients with RA. It is hypothesized that patients with RA have a higher prevalence of periodontitis.…”

mentioning

confidence: 99%

Cross‐Sectional Evaluation of Periodontal Status and Microbiologic and Rheumatoid Parameters in a Large Cohort of Patients With Rheumatoid Arthritis

Schmickler

Rupprecht

Patschan³

et al. 2017

Journal of Periodontology

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Periodontal pathogens participate in synovitis in patients with rheumatoid arthritis in clinical remission: a retrospective case–control study

Abstract: More than half of RA patients in remission showed persistent synovitis. This synovitis may be associated with periodontal disease-causing Pi. Thus, treating periodontal disease should also be considered in order to achieve more profound remission of RA.

Cited by 12 publications

References 47 publications

Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

The immune response to Prevotella bacteria in chronic inflammatory disease

Cross‐Sectional Evaluation of Periodontal Status and Microbiologic and Rheumatoid Parameters in a Large Cohort of Patients With Rheumatoid Arthritis

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