OMAHA – Could the periodontal region, much like the joints, be targeted in rheumatoid arthritis (RA)? Or does periodontal disease (PD) set off immune responses that are more severe in some forms of RA?
Those are questions raised by a recent study from the Omaha VA Medical Center and University of Nebraska Medical Center in Omaha.
The report, published recently in the journal Arthritis & Rheumatology, focused on the degree to which shared risk factors explain the relationship of PD to RA and sought to determine the associations of PD and Porphyromonas gingivalis with pathologic and clinical features of RA. 1
For the study, researchers focused on 287 RA patients, comparing them to another 330 patients with osteoarthritis as disease controls, with all participants undergoing a standardized periodontal examination.
Results indicated greater presence of PD in patients with RA (35%) and the subset of 240 patients with anti-citrullinated protein antibody (ACPA)-positive RA (37%) compared to controls (26%).
In addition, PD appeared to be associated with increased titers of rheumatoid factor and anti-CCP2, as well as increased swollen joint counts, higher disease activity as measured by the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and higher levels of radiographic damage.
While no differences were found in prevalence of positivity of P gingivalis in subgingival samples or serum levels of antibody to P gingivalis between patients with RA and those with OA, serum antibody levels to Fusobacterium nucleatum, another oral pathogen, were found to be significantly higher in patients with RA than in OA patients.
“Both PD and P gingivalis appear to shape the auto-reactivity of RA,” the authors conclude. “In addition, these results demonstrate an independent relationship between PD and established seropositive RA.”
1 Mikuls TR, Payne JB, Yu F, Thiele GM, et. al. Periodontitis and Porphyromonas gingivalis in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014 May;66(5):1090-100. doi: 10.1002/art.38348. PubMed PMID: 24782175; PubMed Central PMCID: PMC4115329.
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