Periodontitis and Porphyromonas gingivalis in Patients With Rheumatoid Arthritis. Issue 5 (May 2014)

• Record Type: Journal Article
• Authors: Mikuls, Ted R.; Payne, Jeffrey B.; Yu, Fang; Thiele, Geoffrey M.; Reynolds, Richard J.; Cannon, Grant W.; Markt, Jeffrey; McGowan, David; Kerr, Gail S.; Redman, Robert S.; Reimold, Andreas; Griffiths, Garth; Beatty, Mark; Gonzalez, Shawneen M.; Bergman, Debra A.; Hamilton, Bartlett C.; Erickson, Alan R.; Sokolove, Jeremy; Robinson, William H.; Walker, Clay; Chandad, Fatiha; O'Dell, James R.
• Is Part Of: Arthritis & rheumatology. Volume 66:Issue 5(2014)
• Page Start: 1090
• Page End: 1100
• Publication Date: 2014-05
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/art.38348
• Languages: English
• ISSNs: 2326-5191

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="art38348-sec-0001" sec-type="section"> <title>Objective</title> <p>To examine the degree to which shared risk factors explain the relationship of periodontitis (PD) to rheumatoid arthritis (RA) and to determine the associations of PD and <italic>Porphyromonas gingivalis</italic> with pathologic and clinical features of RA.</p> </sec> <sec id="art38348-sec-0002" sec-type="section"> <title>Methods</title> <p>Patients with RA (n = 287) and patients with osteoarthritis as disease controls (n = 330) underwent a standardized periodontal examination. The <italic>HLA–DRB1</italic> status of all participants was imputed using single‐nucleotide polymorphisms from the extended major histocompatibility complex. Circulating anti–<italic>P gingivalis</italic> antibodies were measured using an enzyme‐linked immunosorbent assay, and subgingival plaque was assessed for the presence of <italic>P gingivalis</italic> using polymerase chain reaction (PCR). Associations of PD with RA were examined using multivariable regression.</p> </sec> <sec id="art38348-sec-0003" sec-type="section"> <title>Results</title> <p>Presence of PD was more common in patients with RA and patients with anti–citrullinated protein antibody (ACPA)–positive RA (n = 240; determined using the anti–cyclic citrullinated peptide 2 [anti–CCP‐2] test) than in controls (35% and 37%, respectively, versus 26%; <italic>P</italic> = 0.022 and <italic>P</italic> = 0.006, respectively). There were no differences between RA patients and controls in the levels of anti–<italic>P gingivalis</italic> or the frequency of <italic>P gingivalis</italic> positivity by PCR. The anti–<italic>P gingivalis</italic> findings showed a weak, but statistically significant, association with the findings for both anti–CCP‐2 (r = 0.14, <italic>P</italic> = 0.022) and rheumatoid factor (RF) (r = 0.19, <italic>P</italic> = 0.001). Presence of PD was associated with increased swollen joint counts (<italic>P</italic> = 0.004), greater disease activity according to the 28‐joint Disease Activity Score using C‐reactive protein level (<italic>P</italic> = 0.045), and higher total Sharp scores of radiographic damage (<italic>P</italic> = 0.015), as well as with the presence and levels of anti–CCP‐2 (<italic>P</italic> = 0.011) and RF (<italic>P</italic> < 0.001). The expression levels of select ACPAs (including antibodies to citrullinated filaggrin) were higher in patients with subgingival <italic>P gingivalis</italic> and in those with higher levels of anti–<italic>P gingivalis</italic> antibodies, irrespective of smoking status. Associations of PD with established seropositive RA were independent of all covariates examined, including evidence of <italic>P gingivalis</italic> infection.</p> </sec> <sec id="art38348-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Both PD and <italic>P gingivalis</italic> appear to shape the autoreactivity of RA. In addition, these results demonstrate an independent relationship between PD and established seropositive RA.</p> </sec> </abstract>