Periodontitis in established rheumatoid arthritis patients: a cross-sectional clinical, microbiological and serological study

Abstract

IntroductionThe association between rheumatoid arthritis (RA) and periodontitis is suggested to be linked to the periodontal pathogen Porphyromonas gingivalis. Colonization of P. gingivalis in the oral cavity of RA patients has been scarcely considered. To further explore whether the association between periodontitis and RA is dependent on P. gingivalis, we compared host immune responses in RA patients with and without periodontitis in relation to presence of cultivable P. gingivalis in subgingival plaque.MethodsIn 95 RA patients, the periodontal condition was examined using the Dutch Periodontal Screening Index for treatment needs. Subgingival plaque samples were tested for presence of P. gingivalis by anaerobic culture technique. IgA, IgG and IgM antibody titers to P. gingivalis were measured by ELISA. Serum and subgingival plaque measures were compared to a matched control group of non-RA subjects.ResultsA higher prevalence of severe periodontitis was observed in RA patients in comparison to matched non-RA controls (27% versus 12%, p < 0.001). RA patients with severe periodontitis had higher DAS28 scores than RA patients with no or moderate periodontitis (p < 0.001), while no differences were seen in IgM-RF or ACPA reactivity. Furthermore, RA patients with severe periodontitis had higher IgG- and IgM-anti P. gingivalis titers than non-RA controls with severe periodontitis (p < 0.01 resp. p < 0.05), although subgingival occurrence of P. gingivalis was not different.ConclusionsSeverity of periodontitis is related to severity of RA. RA patients with severe periodontitis have a more robust antibody response against P. gingivalis than non-RA controls, but not all RA patients have cultivable P. gingivalis.

Kartagener's Syndrome and Rheumatoid Arthritis

“…Recently, epidemiological and pathological relationships between RA and periodontal diseases have been noted (21)(22)(23)(24)(25)(26)(27). These diseases have a similar pathobiology; that is, both types of diseases are characterized by chronic destructive inflammation associated with tumor necrosis factor (TNF) and have common risk factors, including HLA-DRB1 shared epitope alleles and smoking (28).…”

A molecular signature of preclinical rheumatoid arthritis triggered by dysregulated PTPN22

“…Porphyromonas gingivalis, the most common pathogen of periodontitis, expresses a PAD-like enzyme that is capable of citrullinating host proteins (6,7). Several epidemiological studies have suggested an association between periodontitis and risk of developing ACPA or RA (8)(9)(10). In addition, a functional haplotype stabilizing the mRNA from padi4, the gene encoding PAD4, is associated with a higher risk of RA and the presence of ACPA in RA patients (11)(12)(13)(14).…”

Problems of Rheumatoid Arthritis Immunopathology: Evolution of the Disease

“…Во многих иссле-дованиях было показано увеличение распространенности РА у пациентов с периодонтитом [140], а также связь меж-ду развитием периодонтита, серопозитивностью по РФ/АЦБ и активностью РА [141,142]. В воспаленном пе-риодонте наблюдается увеличение экспрессии ПАД, со-держания цитруллинированных белков [143], а в десенной жидкости -увеличение уровня АЦБ [144].…”