Periodontal status correlates with anti‐citrullinated protein antibodies in first‐degree relatives of individuals with rheumatoid arthritis

Abstract

Aim To evaluate periodontal status in first‐degree relatives of patients with rheumatoid arthritis (FDR‐RA) and detect correlation with the presence of anti‐citrullinated protein antibodies (ACPAs). Materials and Methods Rheumatologic status and periodontal status were evaluated in a nested case–control study of FDR‐RA with no diagnosis of RA at enrolment. The following parameters were assessed in 34 ACPA‐positive (ACPA+) and 65 ACPA‐negative (ACPA−) subjects: gingival index (GI), plaque index (PI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL). We compared the two groups using conditional logistic regression. Results In ACPA+ individuals, the mean, PD, BOP, CAL and number of sites per person with PD > 4 mm and BOP were significantly higher compared to the ACPA‐ group. All ACPA+ subjects had periodontitis: 44.1% presenting moderate and 47.1% severe periodontitis. ACPA‐ subjects had mainly mild (30.8%) and moderate (27%) periodontitis, differences being significantly different for both moderate periodontitis (p = 0.001) and severe periodontitis (p < 0.001). In multivariable analyses, ACPA status (p = 0.04) and age (p = 0.002) were significantly and independently associated with periodontal conditions. Conclusion High prevalence and severity of periodontitis in FDR‐RA was associated with seropositivity to ACPAs. This further strengthens the hypothesis that periodontitis may be a risk factor in the development of RA.

Mini-Review: Human Microbiome and Rheumatic Diseases

“…Interestingly, within population genetically at-risk for RA, ACPA-positives individuals have higher prevalence and severity of periodontitis than ACPA-negative subjects (Loutan et al, 2019). The latter suggests a causal role for periodontitis in the development of systemic auto-immunity preceding RA onset.…”

Periodontal Disease in Diabetes Mellitus: A Case–Control Study in Smokers and Non-Smokers

“…Studies have established that periodontal status and systemic diseases have an effect on each other [1]. The most studied interactions are those between periodontal disease (PD) and cardiovascular conditions [2], rheumatoid arthritis [3][4][5] and diabetes [6][7][8], but relationships between PD and hypertension [8], osteoporosis [9], psoriasis [10,11] pulmonary diseases [12], pregnancy and perinatal complications [13][14][15] have also been shown.…”

Measuring ACPA in the general population or primary care: is it useful?

“…Thus, the PPV for RA at 5 years for a positive ACPA test was 58% in first degree relatives of patients with RA,67 and the PPV for RA at 5 years was 56% in a particular indigenous American Indian tribe 68. While the PPV for RA in these individuals at risk for RA may vary substantially depending on the strength of the genetic risk or the prevalence of other conditions known to promote the production of ACPAs,60–63 the PPV of ACPAs is overall substantially better when screening populations at higher a priori risk for the disease (figure 1). Other at risk populations warranting screening could be groups exposed to specific environmental risk factors of RA or having specific comorbidities that put them at higher risk.…”

“…The limited sensitivity of the test can be explained by the fact that not all patients with RA seem to have autoantibodies (‘seronegative disease’), even if in some of the patients with ACPA-negative RA have other autoantibodies. The limited specificity of ACPAs can be explained by the fact that these antibodies also occur in other conditions, such as periodontal disease,60 61 chronic lung diseases62 or other autoimmune diseases 63…”

“…Other autoimmune comorbidities, such as autoimmune thyroiditis, have been demonstrated to increase the risk of RA and may justify regular screening for RA 73. Chronic periodontitis, chronic interstitial lung disease or chronic diarrhoea have also been proposed as comorbid conditions increasing the risk for future RA 60–62 74 75. In order to integrate the different risk factors, clinical prediction rules have been developed to estimate the risk of progression to RA 76.…”