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Raittio E, Nascimento GG, Lopez R, Baelum V. Exploring the Bidirectional Relationship Between Periodontitis and Rheumatoid Arthritis in a Large Danish Cohort. ACR Open Rheumatol 2024. [PMID: 38967301 DOI: 10.1002/acr2.11718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE We investigated the bidirectional relationship between rheumatoid arthritis (RA) and periodontitis and their cross-sectional association using national administrative health care data. METHODS The sample included 3,308,903 individuals aged 20 to 79 years who resided in Denmark in 2000 and had remained free of RA and periodontitis in the previous 10 years. RA and periodontitis were defined using diagnosis and treatment codes. Marginal structural survival models were employed to estimate the effects of RA on periodontitis incidence and vice versa from 2000 to 2017. Using a cross-sectional sample of 2,574,536 individuals from 2017, the association of periodontitis with RA was investigated using regression analyses and probabilistic quantitative bias analyses, simulating RA and periodontitis misclassification and unmeasured confounding of smoking. RESULTS Between 2000 and 2017, 20,348 individuals developed RA and 740,799 developed periodontitis. The estimated hazard ratio (HR) for the effect of periodontitis on incident RA was 1.05 (95% confidence interval [CI] 0.88-1.25), resulting in a restricted mean survival time difference of one day. The HR for the effect of RA on incident periodontitis was 0.84 (95% CI 0.80-0.88), corresponding to a restricted mean survival time difference of 151 days. Cross-sectionally, the unadjusted prevalence ratio for the association was 1.15 (95% CI 1.11-1.19), whereas the estimate adjusted for measured and simulated confounding was practically null (0.99, 95% simulation interval 0.93-1.04). CONCLUSION These findings challenge previously reported bidirectional relationships between periodontitis and RA, pointing to potential residual confounding as an important link and prompting reconsideration of the biologic plausibility and clinical significance of these associations.
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Affiliation(s)
- Eero Raittio
- Aarhus University, Aarhus, Denmark, and University of Eastern Finland, Kuopio, Finland
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, and Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Rodrigo Lopez
- Aarhus University, Aarhus, Denmark, University of Bergen, Bergen, Norway, and Pontificia Universidad Católica de Chile, Santiago, Chile
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Kang HS, Kim JH, Kim JH, Bang WJ, Choi HG, Yoo DM, Lee NE, Han KM, Kim NY, Park HY, Min KW, Kwon MJ. The Association of Chronic Periodontitis as a Potential Risk Factor with Rheumatoid Arthritis: A Nested Case-Control Study Using a Korean National Health Screening Cohort. Biomedicines 2024; 12:936. [PMID: 38790898 PMCID: PMC11118670 DOI: 10.3390/biomedicines12050936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
Growing research has proposed that rheumatoid arthritis (RA) and chronic periodontitis (CP) share similar pathophysiological mechanisms involving inflammation and tissue destruction. However, the potential correlation of CP as a contributing factor for the occurrence of RA warrants validation in the Korean population, where both diseases are prevalent, especially considering the increasingly aging demographic in Korea. This study examined 5139 RA cases and 509,727 matched controls from a Korean national cohort dataset (2002-2019) by carefully employing propensity score matching to ensure comparability between groups. Baseline characteristics were compared using standardized differences, and logistic regression was employed to estimate the impact of CP history on RA likelihood while controlling for covariates. We fully examined medical records documenting CP occurrences within the two-year period leading up to the index date, conducting comprehensive subgroup analyses. While a 1-year history of CP did not show a significant association with likelihood of RA, a 2-year history of CP increased RA likelihood by 12%, particularly among older adults, females, rural residents, and those with certain comorbidities such as hypercholesterolemia. Interestingly, this association persisted even among individuals with non-smoking habits, normal weight, and infrequent alcohol consumption. These findings suggest that chronic CP exposure for at least 2 years may independently elevate RA risk in Korean adults. The association in certain subgroups appears to suggest a predisposition toward genetic susceptibilities over lifestyle and environmental factors. Predicting RA in CP patients may be challenging, emphasizing the importance of regular RA screening, especially in high-risk subgroups.
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Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Na-Eun Lee
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kyeong Min Han
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu 11759, Republic of Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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Batool A, Vaithilingam RD, Mohamad Hassan NH, Safii SH, Saub R. Evaluating the potential of matrix metalloproteinase as a diagnostic biomarker in rheumatoid arthritis and periodontitis: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35340. [PMID: 37832126 PMCID: PMC10578754 DOI: 10.1097/md.0000000000035340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) play a crucial role in the pathogenesis of several chronic diseases including rheumatoid arthritis (RA) and periodontitis (PD). RA patients with periodontitis (RA-PD) are associated with elevated inflammatory burden due to increased production of proinflammatory cytokines. Controlling upregulated MMPs activity in these patients may have potential therapeutic effects. Therefore, aim of this study is to address the focused question: "Do RA subjects with concurrent PD have different levels of MMPs in comparison to RA alone, PD alone and HC subjects?" METHODS The systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search from 4 electronic databases (EMBASE, Medline, Web of Science, and Cochrane library) and manual search was performed from inception to July 2023. Quality assessment of each article was done using Newcastle-Ottawa Scale. Meta-analyses derived results were summarized as standardized mean difference (SMD) with 95% confidence intervals. RESULTS A total of 879 articles were extracted. Following screening and full text assessment, 9 studies were included. MMP-1, MMP-3, MMP-8, MMP-9, and MMP-13 were consistently elevated in RA-PD subjects. MMP-8 levels were found to be higher in RA-PD subjects compared with RA alone, PD alone, and HC in 3 studies reporting GCF levels (SMD = 1.2; Z = 2.07; P = .04) and 2 studies reporting serum levels (SMD = 0.87; Z = 4.53; P < .00001). CONCLUSION RA-PD group showed significantly higher MMP levels in their serum and GCF compared with HC, RA, and PD alone individuals. MMP-8 may serve as a reliable biomarker in the diagnosis and management of RA-PD subjects.
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Affiliation(s)
- Aimen Batool
- Department of Community Oral Health & Clinical Prevention, University Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Roslan Saub
- Department of Community Oral Health & Clinical Prevention, University Malaya, Kuala Lumpur, Malaysia
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Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Periodontitis and risk of immune-mediated systemic conditions: A systematic review and meta-analysis. Community Dent Oral Epidemiol 2023; 51:705-717. [PMID: 36377800 DOI: 10.1111/cdoe.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/22/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this review is to examine and quantify the long-term risk of immune-mediated systemic conditions in people with periodontitis compared to people without periodontitis. METHODS Medline, EMBASE and Cochrane databases were searched up to June 2022 using keywords and MeSH headings. The 'Risk of Bias in Non-Randomised Studies of Interventions' tool was used to assess bias. Cohort studies comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy controls were included. Meta-analysis and meta-regression quantified risks and showed impact of periodontitis diagnosis type and severity. RESULTS The search retrieved 3354 studies; 166 studies were eligible for full-text screening, and 30 studies were included for review. Twenty-seven studies were eligible for meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in people with periodontitis compared to without periodontitis (diabetes-relative risk [RR]: 1.22, 95% CI: 1.13-1.33; RA-RR: 1.27, 95% CI: 1.07-1.52; osteoporosis-RR: 1.40, 95% CI: 1.12-1.75). Risk of diabetes showed gradient increase by periodontitis severity (moderate-RR = 1.20, 95% CI = 1.11-1.31; severe-RR = 1.34, 95% CI = 1.10-1.63). CONCLUSION People with moderate-to-severe cases of periodontitis have the highest risk of developing diabetes, while the effect of periodontal severity on risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is required to form robust conclusions regarding periodontitis-multimorbidity associations.
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Affiliation(s)
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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Bolstad AI, Fevang BTS, Lie SA. Increased risk of periodontitis in patients with rheumatoid arthritis: A nationwide register study in Norway. J Clin Periodontol 2023; 50:1022-1032. [PMID: 37202856 DOI: 10.1111/jcpe.13826] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/16/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
AIM To investigate the risk of periodontitis in rheumatoid arthritis (RA) patients in a nationwide register-based study. MATERIALS AND METHODS Patients and controls were defined using ICD-10 codes registered in the Norwegian Patient Registry (NPR), from 2011 to 2017. The 324,232 included subjects had at least one registered diagnostic code for RA (33,040 patients) or diagnostic codes for non-osteoporotic fractures or hip or knee replacement due to osteoarthritis (controls). The outcome was periodontitis, defined by codes for periodontal treatment from the Norwegian Control and Payment of Health Reimbursements Database (KUHR). Hazard ratios (HRs) were calculated for periodontitis in RA patients compared to controls. Generalized additive model in Cox regressions was estimated to visualize periodontitis occurrences as a function of number of RA visits. RESULTS The risk of periodontitis increased with increasing number of RA visits. RA patients having 10 or more visits during the 7-year period had a 50% increased risk of periodontitis compared to controls (HR = 1.48, 95% confidence interval [CI]: 1.39-1.59); also, in patients with assumed new RA, an even higher risk estimate was seen (HR = 1.82, 95% CI: 1.53-2.17). CONCLUSIONS In this register-based study in which periodontal treatment was used as a surrogate marker for periodontitis, we found an increased risk of periodontitis in RA patients, particularly those with active disease and new RA.
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Affiliation(s)
- Anne Isine Bolstad
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bjørg-Tilde Svanes Fevang
- Department of Clinical Science, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopedics, Haukeland University Hospital, Bergen, Norway
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Posada-López A, Duque JD, Pineda-Tamayo RA, Bedoya-Giraldo E, Botero JE. Lack of association between periodontitis and rheumatoid arthritis. REUMATOLOGIA CLINICA 2023; 19:123-129. [PMID: 36906387 DOI: 10.1016/j.reumae.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/17/2022] [Indexed: 03/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Periodontitis and rheumatoid arthritis (RA) have been associated in a bidirectional way. The objective of this study was to determine the association between clinical parameters of periodontitis and RA. MATERIALS AND METHODS Seventy-five (75) participants distributed in 3 groups (21 patients with periodontitis without RA, 33 patients with periodontitis with RA and 21 patients with reduced periodontium with RA) were included in this cross-sectional study. A full periodontal and medical examination was performed in each patient. Additionally, subgingival plaque samples for the detection of Porphyromonas gingivalis (P. gingivalis) and blood samples for biochemical markers of RA were also taken. Logistic regression analysis adjusted for confounding variables, Spearman's rank correlation coefficient and a linear multivariate regression were used to analyze the data. RESULTS Patients with RA presented less severity of periodontal parameters. The highest levels of anti-citrullinated protein antibodies were detected in non-periodontitis patients with RA. Covariates such as age, P. gingivalis, diabetes, smoking, osteoporosis and use of medication were not associated with RA. All periodontal variables and P. gingivalis expressed a negative correlation with biochemical markers of RA (P<0.05). CONCLUSIONS Periodontitis was not associated with RA. Furthermore, there was no correlation between periodontal clinical parameters and biochemical markers of RA.
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Affiliation(s)
| | - Jose Daniel Duque
- Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
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Antonoglou GN, Romandini M, Meurman JH, Surakka M, Janket SJ, Sanz M. Periodontitis and edentulism as risk indicators for mortality: Results from a prospective cohort study with 20 years of follow-up. J Periodontal Res 2023; 58:12-21. [PMID: 36282792 PMCID: PMC10092146 DOI: 10.1111/jre.13061] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM To investigate the association between periodontitis and edentulism with cardiovascular disease (CVD) and all-cause mortality. METHODS Baseline data of 506 subjects including 256 angiographically verified coronary artery disease patients and 250 matched participants in cardiovascular health from the Kuopio Oral Health and Heart study were collected from 1995-1996. Mortality data were accrued until May 31, 2015, and related to baseline periodontal health and edentulism, assessed as exposure and collected by means of clinical and radiographic examination by a single examiner. Cox proportional hazards regression models were fit using covariates such as age, gender, smoking, BMI, and education. The final sample size for the periodontitis models ranged from 358 to 376, while the edentate models included 413 to 503 subjects for CVD and all-cause mortality, respectively with no missing values in the predictor, confounders, and outcome. RESULTS The strongest association was found between edentulism and CVD and all-cause mortality (HR: 1.9 CVD , HR: 1.6all-cause ; p < .01). CONCLUSIONS Edentulism considered as a poor oral health marker was associated strongly with CVD mortality while periodontitis was not.
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Affiliation(s)
- Georgios N Antonoglou
- ETEP Research Group (Etiology and Therapy of Periodontal and Peri-implant Diseases), Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.,Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Mario Romandini
- ETEP Research Group (Etiology and Therapy of Periodontal and Peri-implant Diseases), Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Surakka
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sok-Ja Janket
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Center for Clinical and Translational Research, The Forsyth Institute, Massachusetts, Cambridge, USA
| | - Mariano Sanz
- ETEP Research Group (Etiology and Therapy of Periodontal and Peri-implant Diseases), Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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Immune dysregulation and pathogenic pathways mediated by common infections in rheumatoid arthritis. Folia Microbiol (Praha) 2023; 68:325-335. [PMID: 36680729 DOI: 10.1007/s12223-023-01036-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
Rheumatoid arthritis (RA) is one of the world's most prevalent inflammatory autoimmune diseases, affecting between 0.4 and 1.3% of the population. The susceptibility to RA appears to be influenced by a complex interaction between a favorable genetic background and the existence of a specific immune reaction against a wide range of environmental variables. Among the known environmental variables, infections are believed to have a significant role in promoting the formation of autoimmune disorders, which are frequently caused by specific microorganisms. Infections have been linked to RA in recent medical studies. In this study, we selected the most prevalent infections associated with RA from the literature and described the data confirming their pathogenic role in RA. Our investigation included Mycobacterium, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Proteus mirabilis, Epstein-Barr virus, parvovirus, and Prevotella copri.
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9
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Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, Alpizar-Rodriguez D, Lauper K. Global epidemiology of rheumatoid arthritis. Nat Rev Rheumatol 2022; 18:591-602. [PMID: 36068354 DOI: 10.1038/s41584-022-00827-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease that predominantly affects the joints. The prevalence of RA varies globally, with generally a higher prevalence in industrialized countries, which may be explained by exposures to environmental risk factors, but also by genetic factors, differing demographics and under-reporting in other parts of the world. Over the past three decades, strong trends of the declining severity of RA probably reflect changes in treatment paradigms and overall better management of the disease. Other trends include increasing RA prevalence. Common risk factors for RA include both modifiable lifestyle-associated variables and non-modifiable features, such as genetics and sex. A better understanding of the natural history of RA, and of the factors that contribute to the development of RA in specific populations, might lead to the introduction of specific prevention strategies for this debilitating disease.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.
| | - Benoît Gilbert
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Bridget Hodkinson
- Division of Rheumatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kevin D Deane
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kim Lauper
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.,Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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Romão VC, Fonseca JE. Disease mechanisms in preclinical rheumatoid arthritis: A narrative review. Front Med (Lausanne) 2022; 9:689711. [PMID: 36059838 PMCID: PMC9437632 DOI: 10.3389/fmed.2022.689711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
In the last decades, the concept of preclinical rheumatoid arthritis (RA) has become established. In fact, the discovery that disease mechanisms start years before the onset of clinical RA has been one of the major recent insights in the understanding of RA pathogenesis. In accordance with the complex nature of the disease, preclinical events extend over several sequential phases. In a genetically predisposed host, environmental factors will further increase susceptibility for incident RA. In the initial steps of preclinical disease, immune disturbance mechanisms take place outside the joint compartment, namely in mucosal surfaces, such as the lung, gums or gut. Herein, the persistent immunologic response to altered antigens will lead to breach of tolerance and trigger autoimmunity. In a second phase, the immune response matures and is amplified at a systemic level, with epitope spreading and widening of the autoantibody repertoire. Finally, the synovial and bone compartment are targeted by specific autoantibodies against modified antigens, initiating a local inflammatory response that will eventually culminate in clinically evident synovitis. In this review, we discuss the elaborate disease mechanisms in place during preclinical RA, providing a broad perspective in the light of current evidence.
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Affiliation(s)
- Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
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Treatment resistance of rheumatoid arthritis relates to infection of periodontal pathogenic bacteria: a case-control cross-sectional study. Sci Rep 2022; 12:12353. [PMID: 35854051 PMCID: PMC9296452 DOI: 10.1038/s41598-022-16279-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
Recent studies have shown that periodontitis is associated with rheumatoid arthritis (RA) and periodontal bacteria, such as Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) are involved in the pathogenesis of RA via citrullinated proteins. Smoking has also been shown to be involved in the pathogenesis of RA; however, the extent of this involvement is still poorly understood. In addition, RA and polymyalgia rheumatica (PMR) are sometimes difficult to differentiate; however, the relationship between PMR and the factors from smoking and periodontal bacteria is unclear. The aim of this study was to clarify the relationship between periodontal pathogenic bacterial infections and smoking in patients with RA or PMR. This case–control study included 142 patients with untreated RA or PMR. This study evaluated the serum antibody titers against periodontal pathogenic bacterial antigens and an anti-citrullinated peptide antibody (ACPA). In patients with RA, the relationship between antibody titers and disease activity of RA and response after 3 months of treatment was also investigated. Additionally, the effects of smoking were evaluated. Although there was no significant difference in serum antibody titer against periodontal pathogenic bacteria between the ACPA-positive RA group and the ACPA-negative PMR group, we found an association between the elevated antibody titer against Pg and the degree of ACPA value, especially between negative group and high-value positive group (≥ 100 U/mL). The antibody titers against Aa and Pg did not differ depending on disease activity score 28 (DAS28) at baseline; however, patients with high antibody titers had poor RA therapeutic response as judged by DAS28 after 3 months. We could not find any association between smoking and any of these parameters. Periodontal pathogenic bacteria, especially Pg, are associated with elevated ACPA levels. Our findings suggest that Pg and Aa infections interfere with the therapeutic response of RA.
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Zhang Y, Leveille SG, Shi L. Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population. Front Big Data 2022; 5:932618. [PMID: 35844965 PMCID: PMC9283677 DOI: 10.3389/fdata.2022.932618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Half of US adults aged 20–64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on multiple chronic diseases and on having two or more concurrent chronic diseases (multimorbidity) in relation to tooth loss are lacking. Therefore, this study aimed to assess the association between multiple chronic diseases, multimorbidity, and tooth loss in US adults. Methods We performed a secondary data analysis using the US 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey studying health conditions and health behaviors among US adults (≥18 years) who are non-institutionalized residents. Variables were derived from the BRFSS Standard Core Questionnaire. Descriptive analysis including means, standard deviations (SDs), and percentages was calculated. Sample weights were applied. The stepwise multinomial logistic regression method was used to examine the relationship between several chronic diseases and tooth loss. Separate multinomial logistic regression models were used to examine the relationship between multimorbidity and tooth loss among all adults aged more than 18 years, adults aged 18–64 years, and adults aged more than 65 years, respectively. Results Among the samples (n = 471,107, mean age 55 years, 60% female), 55% reported losing no tooth loss, 30% reported losing one to five teeth, 10% reported losing six or more but not all teeth, and 5% reported losing all teeth. After adjusting for demographic characteristics, socioeconomic status, smoking, BMI, and dental care, chronic diseases that were associated with edentulism were chronic obstructive pulmonary disease (COPD) [adjusted risk ratio (adj. RR) 2.18, 95% confidence interval (CI) 2.08–2.29]; diabetes (adj. RR 1.49, 95% CI 1.44–1.56); arthritis (adj. RR 1.49, 95% CI 1.44–1.54); cardiovascular disease (adj. RR 1.38, 95% CI 1.30–1.45); stroke (adj. RR 1.31, 95% CI 1.24–1.40); kidney disease (adj. RR 1.16, 95% CI 1.08–1.25); cancer (adj. RR 1.05, 95% CI 1.01–1.11); and asthma (adj. RR 1.07, 95% CI 1.02–1.12). For those who reported losing six or more teeth, the association remained significant for all the chronic diseases mentioned, albeit the magnitude of association appeared to be comparative or smaller. In addition, adults with multimorbidity were more likely to have tooth loss (loss of one to five teeth: adj. RR 1.17, 95% CI 1.14–1.19; loss of six or more teeth: adj. RR 1.78, 95% CI 1.73–1.82; edentulous: adj. RR 2.03, 95% CI 1.96–2.10). Conclusions Multiple chronic diseases were associated with edentulism and tooth loss. People with multimorbidity are more likely to be edentulous than those with one or no chronic disease. The findings from this study will help to identify populations at increased risk for oral problems and nutritional deficits, thus the assessment of oral health should be evaluated further as an important component of chronic illness care.
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Affiliation(s)
- Yuqing Zhang
- College of Nursing, University of Cincinnati, Mason, OH, United States
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
- *Correspondence: Yuqing Zhang
| | - Suzanne G. Leveille
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ling Shi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
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13
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Zekeridou A, Gilbert B, Finckh A, Giannopoulou C. Periodontitis in First Degree-Relatives of Individuals With Rheumatoid Arthritis: A Short Narrative Review. FRONTIERS IN ORAL HEALTH 2022; 3:895753. [PMID: 35601818 PMCID: PMC9120603 DOI: 10.3389/froh.2022.895753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Periodontal disease (PD) and rheumatoid arthritis (RA) are chronic inflammatory diseases with a bi-directional relationship. Both share common genetic and environmental risk factors and result in the progressive destruction of bone and connective tissue. First degree relatives of patients with RA (FDR-RA) are one of the at-risk populations for RA. The etiopathogenic mechanisms of their susceptibility are currently being explored, focusing mostly on the role of anti–cyclic citrullinated protein/ peptide antibodies (ACPA) in triggering RA. Oral microbiota and their relation with oral health has been suggested as a factor influencing the risk of the FDR-RA developing RA. In particular, compromised periodontal status often correlates with ACPA seropositivity in FDR-RA. The presence of periodontal pathogens such as Porphyromonas gingivalis, in oral microbiota has been proposed to increase the risk of developing RA through its uniquely expressed peptidyl arginine deiminase (PPAD), capable of citrullinating both host and bacterial peptides. Aggregatibacter actinomycetemcomitans and its leukotoxin A (LtxA), also induces hypercitrullination in host neutrophils. Common risk factors of periodontitis and RA such as genetic predisposition, smoking, higher local and systemic inflammatory burden, are discussed in the literature. Based on those mechanisms periodontal disease seems to be presented as one of the factors triggering RA in FDR-RA. Larger studies evaluating all the potential mechanisms linking RA and periodontitis are needed in FDR-RA to confirm that periodontal disease should be considered in the screening of FDR-RA.
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Affiliation(s)
- Alkisti Zekeridou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Alkisti Zekeridou ;
| | - Benoit Gilbert
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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14
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Looh SC, Soo ZMP, Wong JJ, Yam HC, Chow SK, Hwang JS. Aggregatibacter actinomycetemcomitans as the Aetiological Cause of Rheumatoid Arthritis: What Are the Unsolved Puzzles? Toxins (Basel) 2022; 14:toxins14010050. [PMID: 35051027 PMCID: PMC8777676 DOI: 10.3390/toxins14010050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 01/23/2023] Open
Abstract
Leukotoxin A (LtxA) is the major virulence factor of an oral bacterium known as Aggregatibacter actinomycetemcomitans (Aa). LtxA is associated with elevated levels of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis (RA) patients. LtxA targets leukocytes and triggers an influx of extracellular calcium into cytosol. The current proposed model of LtxA-mediated hypercitrullination involves the dysregulated activation of peptidylarginine deiminase (PAD) enzymes to citrullinate proteins, the release of hypercitrullinated proteins through cell death, and the production of autoantigens recognized by ACPA. Although model-based evidence is yet to be established, its interaction with the host’s immune system sparked interest in the role of LtxA in RA. The first part of this review summarizes the current knowledge of Aa and LtxA. The next part highlights the findings of previous studies on the association of Aa or LtxA with RA aetiology. Finally, we discuss the unresolved aspects of the proposed link between LtxA of Aa and RA.
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Affiliation(s)
- Sung Cheng Looh
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia; (S.C.L.); (H.C.Y.)
| | - Zoey May Pheng Soo
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia; (Z.M.P.S.); (J.J.W.)
| | - Jia Jia Wong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia; (Z.M.P.S.); (J.J.W.)
| | - Hok Chai Yam
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia; (S.C.L.); (H.C.Y.)
| | | | - Jung Shan Hwang
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Malaysia
- Correspondence:
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15
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Romão VC, Fonseca JE. Etiology and Risk Factors for Rheumatoid Arthritis: A State-of-the-Art Review. Front Med (Lausanne) 2021; 8:689698. [PMID: 34901047 PMCID: PMC8661097 DOI: 10.3389/fmed.2021.689698] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common systemic inflammatory rheumatic disease. It is associated with significant burden at the patient and societal level. Extensive efforts have been devoted to identifying a potential cause for the development of RA. Epidemiological studies have thoroughly investigated the association of several factors with the risk and course of RA. Although a precise etiology remains elusive, the current understanding is that RA is a multifactorial disease, wherein complex interactions between host and environmental factors determine the overall risk of disease susceptibility, persistence and severity. Risk factors related to the host that have been associated with RA development may be divided into genetic; epigenetic; hormonal, reproductive and neuroendocrine; and comorbid host factors. In turn, environmental risk factors include smoking and other airborne exposures; microbiota and infectious agents; diet; and socioeconomic factors. In the present narrative review, aimed at clinicians and researchers in the field of RA, we provide a state-of-the-art overview of the current knowledge on this topic, focusing on recent progresses that have improved our comprehension of disease risk and development.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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16
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González-Febles J, Sanz M. Periodontitis and rheumatoid arthritis: What have we learned about their connection and their treatment? Periodontol 2000 2021; 87:181-203. [PMID: 34463976 DOI: 10.1111/prd.12385] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Rheumatoid arthritis and periodontitis are chronic inflammatory diseases defined respectively by the destruction of the articular cartilage and tooth-supporting periodontal tissues. Although the epidemiologic evidence for an association between these two diseases is still scarce, there is emerging scientific information linking specific bacterial periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, in the citrullination process, leading to autoantibody formation and compromised immunotolerance of the susceptible patient to rheumatoid arthritis. In this review, we update the existing information on the evidence, not only regarding the epidemiologic association, but also the biologic mechanisms linking these two diseases. Finally, we review information emerging from intervention studies evaluating whether periodontal treatment could influence the initiation and progression of rheumatoid arthritis.
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Affiliation(s)
- Jerián González-Febles
- Departament of Dental Clinical Specialties, Faculty of Odontology, University Complutense, Madrid, Spain.,Research Group on the Aetiology and Treatment of Periodontal and Periimplant Diseases (ETEP), Faculty of Odontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Departament of Dental Clinical Specialties, Faculty of Odontology, University Complutense, Madrid, Spain.,Research Group on the Aetiology and Treatment of Periodontal and Periimplant Diseases (ETEP), Faculty of Odontology, University Complutense, Madrid, Spain
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17
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Gilbert BTP, Lamacchia C, Mongin D, Lauper K, Trunk E, Studer O, Courvoisier DS, Rubbert-Roth A, Kyburz D, Moeller B, Finckh A. Cohort profile: SCREEN-RA: design, methods and perspectives of a Swiss cohort study of first-degree relatives of patients with rheumatoid arthritis. BMJ Open 2021; 11:e048409. [PMID: 34261688 PMCID: PMC8280908 DOI: 10.1136/bmjopen-2020-048409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Rheumatoid arthritis (RA) is an insidious autoimmune disease, with an immunological onset years before diagnosis. Early interventions in preclinical stages could prevent or minimise the progression towards irreversible joint damage. The SCREEN-RA cohort (Evaluation of a SCREENing strategy for Rheumatoid Arthritis) aims to characterise the preclinical stages of the disease, to identify environmental risk factors, and to discover or validate novel biomarkers predictive for RA development. PARTICIPANTS SCREEN-RA includes an at-risk population for RA, namely first-degree relatives of patients with established RA. FINDINGS TO DATE The cohort started in 2009 is composed of mostly asymptomatic healthy individuals (total n=1458, 7262 person-years), with a mean age of 44 years at enrolment, 74% female and 91% Caucasian ethnicity. During the study period, 16 participants have developed RA. All participants provide baseline serum, DNA and RNA samples, and in a subset, stool samples and oral examination are performed for microbiota assessment. At enrolment, 10% of participants had asymptomatic autoimmunity associated with RA (n=147), 10% presented 'clinically suspect arthralgias' (n=143) and 3% reported arthralgias in conjunction with autoimmunity or high genetic risk (n=51). Studies with this cohort have uncovered risk factors for RA development, such as female hormonal factors, poor oral health or intestinal dysbiosis. FUTURE PLANS Future directions include immunological and 'multiomics' approaches to discover new biological markers of progression towards RA, as well as testing preventive interventions in 'high-risk' population.
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Affiliation(s)
| | - Céline Lamacchia
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Denis Mongin
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, England
| | - Eric Trunk
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Olivia Studer
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | | | | | - Diego Kyburz
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Burkhard Moeller
- Department of Rheumatology, Clinical Immunology and Allergology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
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18
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Schmalz G, Bartl M, Schmickler J, Patschan S, Patschan D, Ziebolz D. Tooth Loss Is Associated with Disease-Related Parameters in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis-A Cross-Sectional Study. J Clin Med 2021; 10:jcm10143052. [PMID: 34300218 PMCID: PMC8305486 DOI: 10.3390/jcm10143052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The aim of this cross-sectional study was to investigate potential associations between periodontal inflamed surface area (PISA) and tooth loss with disease-related parameters in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: Patients who attended the Department of Nephrology and Rheumatology, University Medical Centre Goettingen, Germany, were included. The oral examination comprised the detection of the number of remaining teeth and periodontal condition based on staging and grading matrix. Based on periodontal pockets with positive bleeding on probing, the periodontal inflamed surface area (PISA) was determined. Disease related parameters were extracted from the patients’ records. Results: In total, 101 (RA) and 32 participants (AS) were included. Patients with RA had 22.85 ± 4.26 and AS patients 24.34 ± 5.47 remaining teeth (p < 0.01). Periodontitis stage III and IV was present in 91% (RA) and 81.2% (AS) of patients (p = 0.04). Associations between PISA and disease-related parameters were not found in both groups (p > 0.05). In RA, a higher age (p < 0.01), C-reactive protein (p = 0.02), disease activity (p < 0.01) and prednisolone intake (p < 0.01) were associated with fewer remaining teeth. In AS, a higher age (p = 0.02) and increased Bath Ankylosing Spondylitis Metrology Index (p = 0.02) were associated with a lower number of remaining teeth. Conclusions: Tooth loss is associated with disease activity, especially in RA individuals. Dental care to prevent tooth loss might be recommendable to positively influence oral health condition and disease activity in RA and SA patients.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (M.B.); (J.S.)
| | - Markus Bartl
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (M.B.); (J.S.)
| | - Jan Schmickler
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (M.B.); (J.S.)
| | - Susann Patschan
- Department of Cardiology, Angiology and Nephrology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, 16816 Brandenburg, Germany; (S.P.); (D.P.)
| | - Daniel Patschan
- Department of Cardiology, Angiology and Nephrology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, 16816 Brandenburg, Germany; (S.P.); (D.P.)
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (G.S.); (M.B.); (J.S.)
- Correspondence: ; Tel.: +49-341-97-21211
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19
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Moura MF, Cota LOM, Costa AM, Silva TA, Costa FO. Rheumatoid arthritis associated with the occurrence, severity and extension of periodontitis: A case-control study. J Clin Exp Dent 2021; 13:e389-e396. [PMID: 33841739 PMCID: PMC8020312 DOI: 10.4317/jced.57540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
Background Emerging evidence pointed to a potential association between periodontitis (PE) and rheumatoid arthritis (RA), based on shared characteristics and similarities in risk factors, immunogenetics and pathways of tissue destruction. The aim of this study was to evaluate the potential association between RA and PE, as well as the influence of risk variables in this association. Material and Methods The present case-control study comprised 471 individuals (157 cases with RA and 314 controls) that underwent a full-mouth periodontal examination. The association between risk variables and the occurrence of AR and PE were evaluated through univariate and multivariate logistic analysis. Results Higher frequency (p<0.001), severity (p=0.006) and extension (p=0.018) of PE was observed among the cases when compared to controls. Variables retained in the final multivariate models for the occurrence of PE were: lower number of teeth, smoking, no use of dental floss, ≥4 daily toothbrushing and RA; for the occurrence of RA were: higher age, female gender, smoking, alcohol use and PE. It is important to stress that RA (OR=2.53; 95%CI 1.24-3.86; p<0.001) was retained in the model for PE, and PE (OR=3.12; 95%CI 1.47-4.26; p<0.001) was retained in the model for RA. Conclusions The present study demonstrated a high frequency of PE among individuals with RA and an important association among the occurrence, severity and extension of PE and RA and smoking. Key words:Case-control study, risk factors, periodontitis, rheumatoid arthritis.
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Affiliation(s)
- Marcela-Faria Moura
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís-Otávio-Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Tarcília-Aparecida Silva
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando-Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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20
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Beyer K, Lie SA, Bjørndal B, Berge RK, Svardal A, Brun JG, Bolstad AI. Lipid, fatty acid, carnitine- and choline derivative profiles in rheumatoid arthritis outpatients with different degrees of periodontal inflammation. Sci Rep 2021; 11:5332. [PMID: 33674638 PMCID: PMC7935865 DOI: 10.1038/s41598-021-84122-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/09/2021] [Indexed: 12/22/2022] Open
Abstract
Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases with several pathogenic pathways in common. Evidence supports an association between the diseases, but the exact underlying mechanisms behind the connection are still under investigation. Lipid, fatty acid (FA) and metabolic profile alterations have been associated with several chronic inflammatory diseases, including RA and periodontitis. Mitochondria have a central role in regulating cellular bioenergetic and whole-body metabolic homeostasis, and mitochondrial dysfunction has been proposed as a possible link between the two disorders. The aim of this cross-sectional study was to explore whole-blood FA, serum lipid composition, and carnitine- and choline derivatives in 78 RA outpatients with different degrees of periodontal inflammation. The main findings were alterations in lipid, FA, and carnitine- and choline derivative profiles. More specifically, higher total FA and total cholesterol concentrations were found in active RA. Elevated phospholipid concentrations with concomitant lower choline, elevated medium-chain acylcarnitines (MC-AC), and decreased ratios of MC-AC and long-chain (LC)-AC were associated with prednisolone medication. This may indicate an altered mitochondrial function in relation to the increased inflammatory status in RA disease. Our findings may support the need for interdisciplinary collaboration within the field of medicine and dentistry in patient stratification to improve personalized treatment. Longitudinal studies should be conducted to further assess the potential impact of mitochondrial dysfunction on RA and periodontitis.
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Affiliation(s)
- Kathrin Beyer
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Asbjørn Svardal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Johan G Brun
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Anne Isine Bolstad
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
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21
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Arvikar SL, Hasturk H, Strle K, Stephens D, Bolster MB, Collier DS, Kantarci A, Steere AC. Periodontal inflammation and distinct inflammatory profiles in saliva and gingival crevicular fluid (GCF) compared with serum and joints in rheumatoid arthritis patients. J Periodontol 2021; 92:1379-1391. [PMID: 33611834 DOI: 10.1002/jper.20-0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/27/2020] [Accepted: 02/04/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The association of periodontitis and Porphyromonas gingivalis (Pg) with rheumatoid arthritis (RA) is incompletely understood. To gain further insights, we evaluated periodontal status, oral, serum and joint inflammatory profiles, and Pg biomarkers in RA patients. METHODS In this cross-sectional study, we evaluated 33 patients with predominantly untreated new-onset RA, 20 healthy individuals (HIs), and 20 non-RA chronic periodontitis patients. Thirteen mediators (IFN-γ, IL-10, IL-17A, IL-6, IL-8, CXCL10, TNF-α, CXCL13, IL-23, MMP-1, MMP-3, MMP-8, MMP-9) were measured in serum, synovial fluid, saliva and gingival crevicular fluid (GCF) by multiplex immunoassay. Serum Pg IgG antibodies and subgingival Pg DNA were determined. RESULTS Most RA patients (91%) received routine dental care; only one currently smoked. Ten (30.3%) had periodontal health, 13 (39.4%) had gingivitis, and 10 (30.3%) had periodontitis. Th1 and innate immune responses predominated in serum. Many mediators were concentrated in joints, particularly IL-6, IL-8, and CXCL10. However, salivary and GCF profiles were more restricted, emphasizing neutrophilic inflammation (IL-8, MMP-8) and MMP-9. Compared with HI, most RA patients, regardless of periodontal status, had significantly elevated oral fluid levels of these mediators, with suppression of GCF IL-10, a pattern similar to non-RA periodontitis patients. Pg antibodies or DNA however were primarily associated with clinical periodontitis. CONCLUSIONS Despite routine dental care, RA patients often had inflammation in oral fluids, but inflammatory profiles differed from serum and joints. Neutrophilic inflammatory profiles in oral fluids, regardless of periodontal status, suggests that gingival tissues are a common, and often unrecognized, site of extra-articular inflammation in RA.
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Affiliation(s)
- Sheila L Arvikar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hatice Hasturk
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, Massachusetts
| | - Klemen Strle
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danielle Stephens
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, Massachusetts
| | - Marcy B Bolster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deborah S Collier
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alpdogan Kantarci
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, Massachusetts
| | - Allen C Steere
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Ryu JI, Kim HY, Kwon YD. Is implant surgery a risk factor for osteonecrosis of the jaw in older adult patients with osteoporosis? A national cohort propensity score-matched study. Clin Oral Implants Res 2021; 32:437-447. [PMID: 33452837 DOI: 10.1111/clr.13713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 11/10/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between dental implant therapy and osteonecrosis of the jaw (ONJ) in osteoporotic patients and the relationship between tooth extraction, dental implantation, and ONJ. MATERIAL AND METHODS This retrospective cohort study used the Customized Health Information Data from the National Health Insurance Corporation in South Korea. The study population included patients older than 70 years with a history of osteoporosis; the cases included patients who had undergone dental implant surgery between July 2014 and July 2016 with specific procedure codes. The case and control cohorts were stratified by tooth extraction because it was the strongest risk factor to consider in this study. Each group of patients was matched using the propensity score. To investigate the relationship between dental implants and ONJ, a Cox proportional hazard model was applied to socio-economic factors, comorbidities, and bisphosphonates (BPs). All analyses were conducted using SAS statistical software. RESULTS Based on the fully adjusted model, the propensity score-matched osteoporosis patients with dental implants had a 0.51 times hazard ratio of osteonecrosis. On the contrary, tooth extraction was associated with a higher risk of ONJ (HR = 5.89). The patients with rheumatoid arthritis (RA) and those using BPs had a higher HR, respectively, 6.80 and 4.09 HR (p < .001). CONCLUSIONS Dental implantation was not a risk factor and patients with implants show rather lower ratios. However, older osteoporotic Korean patients who had undergone tooth extraction had higher risks of ONJ. A significantly higher risk of ONJ was associated with RA and BPs as well.
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Affiliation(s)
- Jae-In Ryu
- Department of Preventive and Social Dentistry, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Ha-Young Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, South Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, South Korea
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Vural M, Gilbert B, Üstün I, Caglar S, Finckh A. Mini-Review: Human Microbiome and Rheumatic Diseases. Front Cell Infect Microbiol 2020; 10:491160. [PMID: 33304855 PMCID: PMC7693548 DOI: 10.3389/fcimb.2020.491160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/14/2020] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis and spondyloarthropathy are the most common inflammatory rheumatic diseases. As the human microbiome is involved in the immune homeostasis, it has the potential to be a key factor in the development of autoimmune diseases and rheumatic diseases. In this article, we review the role of various human microbiota on the pathogenesis of rheumatic diseases, focusing on spondylarthritis and rheumatoid arthritis.
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Affiliation(s)
- Meltem Vural
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training Hospital, Istanbul, Turkey
| | - Benoit Gilbert
- Rheumatology Division, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Işıl Üstün
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training Hospital, Istanbul, Turkey
| | - Sibel Caglar
- Physical Medicine and Rehabilitation Clinic, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training Hospital, Istanbul, Turkey
| | - Axel Finckh
- Rheumatology Division, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland
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24
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Nguyen VB, Nguyen TT, Huynh NCN, Le TA, Hoang HT. Relationship between periodontitis and rheumatoid arthritis in Vietnamese patients. Acta Odontol Scand 2020; 78:522-528. [PMID: 32238080 DOI: 10.1080/00016357.2020.1747635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: This study aimed to survey periodontal status of Vietnamese patients with rheumatoid arthritis (RA) and investigates the association between periodontitis and RA in these patients.Materials and methods: We conducted a cross-sectional descriptive study on 150 RA patients and another 150 patients with osteoarthritis (OA). RA was evaluated using the DAS28 disease activity score based on C-reactive protein levels (DAS28-CRP), disease activity classification, and serum levels of RA biomarkers. Periodontal status was determined using periodontal indices.Results: The proportion of periodontitis cases in the RA group was significantly higher than the OA group (67 and 28%, respectively). The rate of severe periodontitis observed in the RA group was also significantly higher than that in the OA group (22.7 and 8%, respectively). RA patients with periodontitis had higher DAS28-CRP scores, disease activity levels, ACPA positivity and higher serum levels of CRP and ACPAs. Periodontitis is associated with an increased risk for RA (odds ratio [OR]: 5.14, 95% confidence interval [CI]: 3.14 - 8.41) and with higher disease activity classification (OR: 2.7, 95% CI: 1.14 - 6.42).Conclusions: Vietnamese RA patients often presented with a more serious periodontal condition than OA patients. We observed an association between periodontal disease (PD) status and clinic symptoms and biochemical/immunological characteristics of RA.
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Affiliation(s)
- Van Bich Nguyen
- Department of Periodontology, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuy Thu Nguyen
- Department of Periodontology, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nam Cong-Nhat Huynh
- Department of Dental Basic Sciences, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Immunology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thu Anh Le
- Faculty of Medicine, Vo Truong Toan University, Ho Chi Minh City, Vietnam
| | - Hung Tu Hoang
- Faculty of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
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Renvert S, Berglund JS, Persson GR, Söderlin MK. The association between rheumatoid arthritis and periodontal disease in a population-based cross-sectional case-control study. BMC Rheumatol 2020; 4:31. [PMID: 32699831 PMCID: PMC7370413 DOI: 10.1186/s41927-020-00129-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background The association between rheumatoid arthritis (RA) and periodontitis remains unclear. Methods We studied oral health and periodontitis in a population-based case-control study of individuals with ≥10 remaining teeth ≥61 years of age and either with, or without a diagnosis of RA. 126 dentate individuals with RA were recruited together with age-matched control individuals without RA. The control individuals were recruited from the general population from the same city (n = 249). A dental examination including a panoramic radiograph was performed on all participants. All individuals with RA were examined and medical records were reviewed by a rheumatologist. In the control group, none of the participants presented with symptoms of RA and their medical records were also negative. Results The RA group included more women (66.7% vs. 55.8%) (p < 0.01). Individuals in the RA group had a higher body mass index (BMI) (p < 0.001). A diagnosis of periodontitis was more common in the RA group (61.1%) than in the control group (33.7%) (p = 0.001). Binary logistic regression analysis identified that a BMI > 25 (OR 6.2, 95% CI 3.6, 10.5, p = 0.000), periodontitis (OR 2.5 95% CI 1.5, 4.2 p = 0.000), and female gender (OR 2.3, 95% CI 1.3–4.0, p = 0.003) were associated with RA. Conclusion RA was associated a diagnosis of periodontitis.
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Affiliation(s)
- Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden.,Department of Health, Blekinge Institute of Technology, SE-371 79 Karlskrona, Sweden.,School of Dental Science, Trinity College, Dublin, Ireland.,Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR China
| | | | - G Rutger Persson
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden.,Departments of Periodontics, and the Department of Oral Medicine, University of Washington, Seattle, WA USA
| | - Maria K Söderlin
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
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Disale PR, Zope SA, Suragimath G, Varma AS, Pisal A. Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis. J Family Med Prim Care 2020; 9:2919-2925. [PMID: 32984149 PMCID: PMC7491801 DOI: 10.4103/jfmpc.jfmpc_398_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Periodontitis is associated with many chronic health conditions including diabetes, cardiovascular disease, and rheumatoid arthritis (RA). RA and periodontitis have similarities in inflammatory mechanism, morphology, and histopathology. Osteoarthritis (OA) is a chronic, multifactorial degenerative disease characterized by the deterioration of cartilage in joints. Objective The aim of this study was to evaluate the prevalence and severity of periodontal disease in patients with established RA and OA. Materials and Methods A total of 200 patients reporting to the Department of Orthopaedics, KIMSDU, Karad were included in the study. Patients were divided into two groups: Group 1 that included 100 patients with established RA diagnosed according to American College of Rheumatology (ACR) classification 1987 criteria and Group 2 that comprised 100 patients diagnosed with OA. Demographic profile, medical and dental history, oral hygiene practices, and smoking status of study participants were recorded. Periodontal status of the patients were evaluated using the simplified oral hygiene index (OHI-S), Loe and Silness gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). On the basis of the CAL score periodontitis severity was defined as slight, moderate, and severe. Rheumatoid Factor (RF) and C-reactive protein (CRP) were considered as a serological marker in RA. Serological tests were performed to measure RF and CRP. Periodontal parameters and serological tests were correlated. Results This study reported 45% severe periodontitis prevalence in RA compared to OA group, which was 33%. Severity of periodontitis is significantly greater in RF positive RA group with mean CAL 5.38 mm compared to RF negative RA group with mean CAL 2.81 mm (P = 0.001). There was moderate positive correlation found between RF titer and severity of periodontitis (r = 0.311). Conclusion The severity of periodontitis was significantly higher among the patients with established RA as compared to patients with OA. RF positive patients had higher periodontal disease compared to RF negative patients. There was an increase in the mean clinical attachment loss with increase in RF titer.
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Affiliation(s)
- Pooja R Disale
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Sameer A Zope
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Girish Suragimath
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Alluri Siddhartha Varma
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Apurva Pisal
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
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Qiao Y, Wang Z, Li Y, Han Y, Zhou Y, Cao X. Rheumatoid arthritis risk in periodontitis patients: A systematic review and meta-analysis. Joint Bone Spine 2020; 87:556-564. [PMID: 32593704 DOI: 10.1016/j.jbspin.2020.04.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Many clinical studies have been carried out to investigate the relationship between periodontitis and rheumatoid arthritis (RA). Owing to limited evidence and inconsistent findings among these studies, it is unclear whether periodontitis would increase the risk for RA. This meta-analysis was performed to evaluate whether periodontitis represents a risk factor for RA. METHODS PubMed, Cochrane Library, Embase, Web of Science, and Wanfang were searched for eligible studies that compared periodontitis patients with controls. A pooled odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association between periodontitis and RA. RESULTS Thirteen studies including a total of 706611 periodontitis patients and 349983 control subjects were included. The pooled OR of RA risk between periodontitis and controls was (OR: 1.69; 95% CI: 1.31-2.17; P<0.0001), indicating that the patients in periodontitis group had a 69% greater risk for RA than people in control group. When stratified by disease type, the pooled results showed periodontitis represents a risk factor for incident RA (OR=1.70, 95%CI: 0.75-3.85, P<0.001) and mixed RA (OR=1.61, 95%CI: 1.26-2.06; P<0.001). When stratified by disease duration, the pooled results showed periodontitis represents a risk factor for RA disease duration>5 years (OR=2.88, 95%CI: 0.66-12.62, P=0.018), disease duration<5 years (OR=2.59, 95%CI: 0.83-8.11, P<0.001), mixed disease duration (OR=1.53; 95%CI: 1.05-2.22, P<0.001). CONCLUSION Our meta-analysis revealed an increased risk of RA in patients with periodontitis compared to healthy controls. Moreover, when stratified by disease type, there was a higher risk between incident RA and periodontitis. When stratified by disease duration, the patients with periodontitis might be more closely associated with the RA patients with disease duration >5 years.
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Affiliation(s)
- Yiqiang Qiao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China
| | - Zao Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China; Zhengzhou Stomotology Hospital, Zhengzhou, 450000, P. R. China
| | - Yafang Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China; Zhengzhou Stomotology Hospital, Zhengzhou, 450000, P. R. China
| | - Yafei Han
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China
| | - Yanheng Zhou
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China
| | - Xuanping Cao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P. R. China.
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Abstract
PURPOSE OF REVIEW To explore the pathogenic association between periodontal disease and rheumatoid arthritis focusing on the role of Porphyromonas gingivalis. RECENT FINDINGS In the last decades our knowledge about the pathogenesis of rheumatoid arthritis substantially changed. Several evidences demonstrated that the initial production of autoantibodies is not localized in the joint, rather in other immunological-active sites. A central role seems to be played by periodontal disease, in particular because of the ability of P. gingivalis to induce citrullination, the posttranslational modification leading to the production of anticitrullinated protein/peptide antibodies, the most sensitive and specific rheumatoid arthritis biomarker. SUMMARY The pathogenic role of P. gingivalis has been demonstrated in mouse models in which arthritis was either triggered or worsened in infected animals. P. gingivalis showed its detrimental role not only by inducing citrullination but also by means of other key mechanisms including induction of NETosis, osteoclastogenesis, and Th17 proinflammatory response leading to bone damage and systemic inflammation.
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29
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Temporomandibular joint function, periodontal health, and oral microbiome in early rheumatoid arthritis and at-risk individuals: a prospective cohort study protocol. BDJ Open 2020; 6:7. [PMID: 32467775 PMCID: PMC7237646 DOI: 10.1038/s41405-020-0034-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/09/2022] Open
Abstract
Objectives/aims Rheumatoid arthritis (RA) is an autoimmune disease affecting the joints, including the temporomandibular joint (TMJ). Early diagnosis and treatment can alleviate symptoms and prevent progression. Predictors for disease outcome in individuals at risk for RA are therefore valuable. While limited information is available on the prevalence of TMJ involvement in early RA, previous studies suggest that RA, periodontitis and the oral microbiome are interrelated. Predictive factors for RA development may thus be present in the oral cavity. Our two aims are: (1) to assess the prevalence of TMJ involvement in early RA, and (2) to investigate the predictive value of oral factors in RA development. Materials and methods We will include 150 individuals in this multi-center, prospective cohort study: 50 patients with early RA, 50 at-risk individuals, and 50 healthy controls. At baseline, the TMJ, periodontal health, and the oral microbiome will be examined. The general health will be followed over time, on four occasions up to 3 years. Discussion Our results will provide insight into the prevalence and clinical characterization of TMJ involvement in early RA. For at-risk individuals, oral factors can be studied as possible predictors for the development of RA.
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Nguyen Y, Mariette X, Salliot C, Gusto G, Boutron-Ruault MC, Seror R. Chronic diarrhoea and risk of rheumatoid arthritis: findings from the French E3N-EPIC Cohort Study. Rheumatology (Oxford) 2020; 59:3767-3775. [DOI: 10.1093/rheumatology/keaa133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/22/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Objectives
To assess the relationship between gastrointestinal disorders and the risk of further development of RA.
Methods
The Etude Epidémiologique auprès des femmes de la Mutuelle générale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition Study is a French prospective cohort including 98 995 healthy women since 1990. Participants completed mailed questionnaires on their lifestyles and health-related information. Gastrointestinal disorders were assessed in the third questionnaire (sent in 1993). Hazard ratios and 95% CIs for incident RA were estimated using Cox proportional hazards regression models with age as the time scale. Models were age adjusted, and then additionally adjusted for known risk factors of RA such as smoking, and for potential cofounders.
Results
Among 65 424 women, 530 validated incident RA cases were diagnosed after a mean (s.d.) of 11.7 (5.9) years after study baseline. In comparison with no gastrointestinal disorder, chronic diarrhoea was associated with an increased risk of developing RA during follow-up (hazard ratio = 1.70, 95% CI 1.13, 2.58), independently of dysthyroidism or dietary habits. The association was stronger among ever-smokers (hazard ratio = 2.21, 95% CI 1.32, 3.70). There was no association between RA risk and constipation or alternating diarrhoea/constipation.
Conclusion
Chronic diarrhoea was associated with an increased risk of subsequent RA development, particularly among ever-smokers. These data fit with the mucosal origin hypothesis of RA, where interaction between intestinal dysbiosis and smoking could occur at an early stage to promote emergence of autoimmunity, followed years later by clinical disease.
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Affiliation(s)
- Yann Nguyen
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, VillejuifFrance
- Internal Medicine Department, AP-HP, Nord, Université de Paris, Hôpital Beaujon, ClichyFrance
| | - Xavier Mariette
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud – Hôpital Bicêtre, Le Kremlin-Bicêtre
- Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Saclay, Le Kremlin-BicêtreFrance
| | - Carine Salliot
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, VillejuifFrance
- Rheumatology Department, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Gaëlle Gusto
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, VillejuifFrance
- Gustave Roussy Institute, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Saclay, Université Paris-Sud, VillejuifFrance
- Gustave Roussy Institute, Villejuif, France
| | - Raphaèle Seror
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud – Hôpital Bicêtre, Le Kremlin-Bicêtre
- Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Saclay, Le Kremlin-BicêtreFrance
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Bartold PM, Lopez‐Oliva I. Periodontitis and rheumatoid arthritis: An update 2012‐2017. Periodontol 2000 2020; 83:189-212. [DOI: 10.1111/prd.12300] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Mark Bartold
- Department of Dentistry University of Adelaide Adelaide South Australia Australia
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Abstract
Rheumatoid Arthritis (RA) is a severe, chronic autoimmune disease that affects 1% of the world's population. Familial risk contributes 50% of the risk of seropositive RA, with strongest risks seen in first-degree relatives. Smoking increases the risk of developing anti-citrullinated peptide antibody (ACPA)+ RA, particularly in individuals with high-risk RA-susceptibility alleles. Other contributory environmental risks including particulate exposure, periodontal disease, bronchiectasis, diet, obesity and the oral contraceptive impact respiratory, oral, intestinal and genital tract mucosal sites. Furthermore, the first signs of autoimmunity may appear at mucosal sites e.g. sputum ACPA-IgA and IgG. While oral and faecal dysbiosis are well described, there is no consistent single bacterial species that appears to drive RA. Animal and human data suggest a model in which multiple environmental influences impact mucosal immune function through the host genetics through enhanced mucosal permeability and the traffic of pro-inflammatory PAMPs and the amplification of autoimmune responses. In some cases, autoimmunity may be driven by cross-reactivity, or mimicry, to pathogen-specific antigens, particularly where the host immune system fails to support their rapid control and elimination.
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Affiliation(s)
- Anne-Sophie Bergot
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, 4102, QLD, Australia
| | - Rabina Giri
- Mater Research Institute-UQ, Faculty of Medicine, University of Queensland, Brisbane, 4102, QLD, Australia
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, 4102, QLD, Australia.
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González-Febles J, Rodríguez-Lozano B, Sánchez-Piedra C, Garnier-Rodríguez J, Bustabad S, Hernández-González M, González-Dávila E, Sanz M, Díaz-González F. Association between periodontitis and anti-citrullinated protein antibodies in rheumatoid arthritis patients: a cross-sectional study. Arthritis Res Ther 2020; 22:27. [PMID: 32054521 PMCID: PMC7020577 DOI: 10.1186/s13075-020-2121-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/06/2020] [Indexed: 12/20/2022] Open
Abstract
AIM The aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS This cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR). RESULTS A significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p < 0.001), and 1.031 (p = 0.031), respectively. Furthermore, a significant increase of 4.45 U/mL in anti-CCP antibodies levels (p = 0.002) in RA patients was found for each pocket ≥ 5 mm after adjusting for age, gender, smoking, time of disease evolution, and RA activity. CONCLUSIONS In RA patients, the severity of periodontal conditions such as mean CAL, mean PI, and the number of pockets ≥ 5 mm were linearly associated with both the presence and levels of anti-CCP antibodies.
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Affiliation(s)
- Jerián González-Febles
- Departamento de Especialidades Odontológicas, Facultad de Odontología, Universidad Complutense, Madrid, Spain
- Grupo de Investigación de Etiología y Tratamiento de las Enfermedades Periodontales (ETEP), Facultad de Odontología, Universidad Complutense, Madrid, Spain
| | | | | | | | - Sagrario Bustabad
- Servicio de Reumatología, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | | | - Enrique González-Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Mariano Sanz
- Grupo de Investigación de Etiología y Tratamiento de las Enfermedades Periodontales (ETEP), Facultad de Odontología, Universidad Complutense, Madrid, Spain
| | - Federico Díaz-González
- Grupo de Investigación de Etiología y Tratamiento de las Enfermedades Periodontales (ETEP), Facultad de Odontología, Universidad Complutense, Madrid, Spain.
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Laguna, C/Ofra s/n, 38320, La Laguna, Spain.
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Kim JW, Park JB, Yim HW, Lee J, Kwok SK, Ju JH, Kim WU, Park SH. Rheumatoid arthritis is associated with early tooth loss: results from Korea National Health and Nutrition Examination Survey V to VI. Korean J Intern Med 2019; 34:1381-1391. [PMID: 30257550 PMCID: PMC6823554 DOI: 10.3904/kjim.2018.093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS To examine the association between rheumatoid arthritis (RA) and periodontitis or tooth loss. METHODS The study used data from the fifth and sixth Korea National Health and Nutrition Examination Surveys conducted from 2010 to 2015. RA was defined as participant-reported physician-diagnosed RA that was being treated. Periodontitis and the number of natural teeth were determined by dental examination. Periodontitis was defined according to the community periodontal index (periodontal probing depth ≥ 4 mm). The association between RA and periodontitis or tooth loss was examined after controlling for confounding variables (e.g., age, smoking status, socioeconomic status, dental caries, frequency of toothbrushing, body mass index, alcohol consumption, and diabetes) in men and women. Subgroup analyses stratified by age were also performed. RESULTS The study enrolled 20,297 participants aged ≥ 19 years (157 RA patients and 20,140 non-RA controls). There was no association between RA and periodontitis or tooth loss in men and women. Subgroup analyses in those aged < 60 years revealed a non-significant association between RA and periodontitis (adjusted odds ratio, 1.53; p = 0.162), but they revealed a significant association between RA and tooth loss (adjusted β, 0.20; p = 0.042). CONCLUSION RA was not associated with periodontitis, but was associated with tooth loss in younger adults. Younger RA patients are more likely to suffer tooth loss than general younger population; thus dental management is required.
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Affiliation(s)
- Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Sung-Hwan Park, M.D. Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6011 Fax: +82-2-599-3589 E-mail:
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Lopez-Oliva I, de Pablo P, Dietrich T, Chapple I. Gums and joints: is there a connection? Part one: epidemiological and clinical links. Br Dent J 2019; 227:605-609. [PMID: 31605071 DOI: 10.1038/s41415-019-0722-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rheumatoid arthritis (RA) and chronic periodontitis are common chronic inflammatory diseases that share numerous clinical and pathobiological characteristics. Due to their similarities, despite manifesting at anatomically distinct sites, the relationship between these two diseases has been investigated for many years. This review attempts to summarise the state of the field based on evidence published in the last ten years.
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Affiliation(s)
| | - Paola de Pablo
- Institute of Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Thomas Dietrich
- Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, UK
| | - Iain Chapple
- University of Birmingham Dental School, Periodontology, Queensway, Birmingham, UK
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Mariette X, Perrodeau E, Verner C, Struillou X, Picard N, Schaeverbeke T, Constantin A, Ravaud P, Bouchard P. Role of good oral hygiene on clinical evolution of rheumatoid arthritis: a randomized study nested in the ESPOIR cohort. Rheumatology (Oxford) 2019; 59:988-996. [DOI: 10.1093/rheumatology/kez368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/02/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objective
There is a relationship between RA and periodontal disease. We aimed to investigate if a good oral hygiene could improve activity of RA.
Methods
The patients with RA according to ACR/EULAR 2010 criteria and included in the French early arthritis ESPOIR cohort were included in a randomized nested study into: (i) intervention group: general recommendations of good oral hygiene including teeth brushing, daily antiseptic mouthwash and twice a year scaling; and (ii) control group: no intervention. The primary end point was the delta DAS28-ESR.
Results
Four hundred and seventy-two patients were randomized (238 in intervention and 234 in control). 92/238 from the intervention group accepted the procedure and 81 had a first visit to the dentist. 56% of patients had periodontal disease at baseline. Duration of RA was 9.0±0.7 years. Baseline DAS28-ESR was 2.7±1.3. After a median duration of 24 months, delta DAS28-ESR was −0.17±1.29 and −0.09±1.28 in intervention and control groups, respectively (mean difference (complier average causal effect): −0.37 (95% CI −1.12, 0.37), P = 0.33). In the intervention group, there was a significant decrease of the bacteria involved in the red complex: Porphyromonas gingivalis (P = 0.002), Tannerella forsythia (P = 0.002) and Treponema denticola (P = 0.019). The patients with baseline periodontal disease and those who became negative for one red complex bacterium had a slightly more important decrease of DAS28-ESR.
Conclusion
Oral hygiene instruction together with regular scaling and polishing of the teeth significantly decreased the load of periodontal pathogens but did not decrease RA activity. This intervention should be tested in patients with earlier RA and more active disease.
Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, NCT01831648.
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Affiliation(s)
- Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique–Hôpitaux de Paris (AP-HP), Université Paris-Sud, INSERM UMR1184, Le Kremlin Bicêtre
| | | | | | - Xavier Struillou
- Department of Periodontology, University of Nantes, Nantes
- INSERM, UMR-S 1229, RMeS, Faculty of Dental Surgery, University of Nantes, Nantes
| | | | | | - Arnaud Constantin
- Department of Rheumatology, Hôpital Pierre-Paul Riquet and Université Toulouse III - Paul Sabatier, Toulouse
| | - Philippe Ravaud
- Department of Epidemiology, Université Paris-Descartes, Paris
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Denis Diderot University
- EA 2496, Paris 5-Descartes University, U.F.R. of Odontology, Paris, France
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Ayala Herrera JL, Apreza Patrón L, Martínez Martínez RE, Domínguez Pérez RA, Abud Mendoza C, Hernández Castro B. Filifactor alocis and Dialister pneumosintes in a Mexican population affected by periodontitis and rheumatoid arthritis: An exploratory study. Microbiol Immunol 2019; 63:392-395. [PMID: 31294852 DOI: 10.1111/1348-0421.12727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 07/01/2019] [Indexed: 01/22/2023]
Abstract
Filifactor alocis and Dialister pneumosintes have been associated with the initiation and progression of periodontitis (PE). We determined and compared the frequency of both bacteria in patients with PE, rheumatoid arthritis (RA), and PE/RA simultaneously. Detection was performed by polymerase chain reaction in the subgingival biofilm. Bacteria were more frequent in patients with PE, and clinical periodontal parameters such as pocket depth (PD) and clinical attachment loss (CAL) were significantly higher in patients with PE/RA. F. alocis and D. pneumosintes could influence PD and CAL, hence participating in the initiation and progression of PE in patients with RA.
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Affiliation(s)
- José Luis Ayala Herrera
- School of Dentistry, De La Salle University, León México, Avenida Universidad 602, Colonia Lomas del Campestre, León, 37150, Guanajuato, Mexico.,Master Program in Advanced Dentistry, Autonomous University of San Luis Potosí, Dr. Manuel Nava 2, University Area, San Luis Potosí, 78290, Mexico
| | - Luis Apreza Patrón
- Master Program in Advanced Dentistry, Autonomous University of San Luis Potosí, Dr. Manuel Nava 2, University Area, San Luis Potosí, 78290, Mexico
| | - Rita Elizabeth Martínez Martínez
- Master Program in Advanced Dentistry, Autonomous University of San Luis Potosí, Dr. Manuel Nava 2, University Area, San Luis Potosí, 78290, Mexico
| | - Rubén Abraham Domínguez Pérez
- Laboratory of Multidisciplinary Dentistry Research, Faculty of Medicine, Autonomous University of Querétaro, Clavel 200, Querétaro, 76176, Mexico
| | - Carlos Abud Mendoza
- Faculty of Medicine, Regional Unit of Rheumatology and Osteoporosis at Central Hospital "Dr. Ignacio Morones Prieto", Avenida Venustiano Carranza, University Area, San Luis Potosí, 78290, Mexico
| | - Berenice Hernández Castro
- Department of Immunology, Research Center of Health Sciences and Biomedicine, School of Medicine, Autonomous University of San Luis Potosí, San Luis Potosí, 78210, Mexico
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de Oliveira Ferreira R, de Brito Silva R, Magno MB, Carvalho Almeida APCPS, Fagundes NCF, Maia LC, Lima RR. Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2019; 11:1759720X19858514. [PMID: 31316593 PMCID: PMC6620730 DOI: 10.1177/1759720x19858514] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/18/2019] [Indexed: 12/22/2022] Open
Abstract
Periodontitis is an inflammatory disease of dental supporting tissues (gingiva, periodontal ligament, and bone) and it has been suggested as a possible etiology for rheumatoid arthritis (RA). In this systematic review, we aim to verify if periodontitis represents a risk factor for RA. Electronic databases were consulted until March 2018 considering eligibility criteria focusing on: (P, participants) adults; (E, exposure) with periodontitis; (C, comparison) without periodontitis; and (O, outcome) development of RA. Quality assessment of studies and risk-of-bias evaluation were also performed. To undertake a quantitative analysis, the number of persons with RA and a total number of participants for the case group (with periodontitis) and control group (without periodontitis) were used to calculate the odds ratio (OR) with a 95% confidence interval (CI). A total of 3888 articles were identified, and nine studies were considered eligible. Seven of 9 articles suggested an association among diseases by the common pro-inflammatory profiles. The pooled analysis of 3 articles showed a higher RA prevalence for persons with periodontitis (n = 1177) than controls (n = 254) (OR 1.97; CI 1.68–2.31; p < 0.00001). However, considerable heterogeneity among studies was verified (I2 = 96%, p < 0.00001). Periodontitis may represent a risk factor for RA by heredity, bacterial infection, and the pro-inflammatory profile shared between both diseases. Although most of the elective studies report an association between periodontitis and RA, the quantitative analysis showed a high heterogeneity, leading to the need for further studies.
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Affiliation(s)
| | - Raíra de Brito Silva
- Laboratory of Functional and Structural Biology, Universidade Federal do Pará, Belém, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Rua Augusto Corrêa 1, Guamá, Belém, PA 66075-900, Brazil
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Zaccardelli A, Friedlander HM, Ford JA, Sparks JA. Potential of Lifestyle Changes for Reducing the Risk of Developing Rheumatoid Arthritis: Is an Ounce of Prevention Worth a Pound of Cure? Clin Ther 2019; 41:1323-1345. [PMID: 31196646 PMCID: PMC6684958 DOI: 10.1016/j.clinthera.2019.04.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Lifestyle may be important in the development of rheumatoid arthritis (RA). Therefore, changing behaviors may delay or even prevent RA onset. This article reviews the evidence basis for the associations of lifestyle factors with RA risk and considers future directions for possible interventions to reduce RA risk. METHODS The literature was reviewed for cross-sectional studies, case-control studies, cohort studies, and clinical trials investigating potentially modifiable lifestyle factors and RA risk or surrogate outcomes on the path toward development such as RA-related autoimmunity or inflammatory arthritis. The evidence related to cigarette smoking, excess weight, dietary intake, physical activity, and dental health for RA risk were summarized. FINDINGS Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior for increased seropositive RA risk. Smoking may increase seropositive RA risk through gene-environment interactions, increasing inflammation and citrullination locally in pulmonary/oral mucosa or systemically, thereby inducing RA-related autoimmunity. Prolonged smoking cessation may reduce seropositive RA risk. Evidence suggests that excess weight can increase RA risk, although this effect may differ according to sex, serologic status, and age at RA onset. TDietary intake may also affect RA risk: overall healthier patterns, high fish/omega-3 polyunsaturated fatty acid consumption, and moderate alcohol intake may reduce RA risk, whereas caffeine and sugar-sweetened soda consumption might increase RA risk. The impact of physical activity is less clear, but high levels may reduce RA risk. Periodontal disease might induce citrullination and RA-related autoimmunity, but the effect of dental hygiene behaviors on RA risk is unclear. Although the effect size estimates for these lifestyle factors on RA risk are generally modest, there may be relatively large public health benefits for targeted interventions given the high prevalence of these unhealthy behaviors. With the exception of smoking cessation, the impact of behavior change of these lifestyle factors on subsequent RA risk has not been established. Nearly all of the evidence for lifestyle factors and RA risk were derived from observational studies. IMPLICATIONS There are many potentially modifiable lifestyle factors that may affect RA risk. Improving health behaviors could have large public health benefits for RA risk given the high prevalence of many of the RA risk-related lifestyle factors. However, future research is needed to establish the effects of lifestyle changes on RA risk or surrogate outcomes such as RA-related autoimmunity or inflammatory arthritis.
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Affiliation(s)
- Alessandra Zaccardelli
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - H Maura Friedlander
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia A Ford
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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40
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Corrêa JD, Fernandes GR, Calderaro DC, Mendonça SMS, Silva JM, Albiero ML, Cunha FQ, Xiao E, Ferreira GA, Teixeira AL, Mukherjee C, Leys EJ, Silva TA, Graves DT. Oral microbial dysbiosis linked to worsened periodontal condition in rheumatoid arthritis patients. Sci Rep 2019; 9:8379. [PMID: 31182740 PMCID: PMC6557833 DOI: 10.1038/s41598-019-44674-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/27/2019] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation. Individuals with RA have a higher risk of periodontitis and periodontitis has been linked to RA through the production of enzymes by periodontal pathogens that citrullinate proteins. This linkage is supported by findings that periodontitis is associated with increased RA severity and treatment of periodontitis can improve the symptoms of RA. The possible mechanism for this association is through dysbiosis of the oral microbiota triggered by RA-induced systemic inflammation. We examined the RA status of subjects by measuring the number of tender and swollen joints, anti-citrullinated protein antibody and rheumatoid factor. Periodontal disease status and salivary cytokine levels were measured, and dental plaque analyzed by 16S rRNA high throughput sequencing. RA patients had a higher bacterial load, a more diverse microbiota, an increase in bacterial species associated with periodontal disease, more clinical attachment loss, and increased production of inflammatory mediators including IL-17, IL-2, TNF, and IFN-γ. Furthermore, changes in the oral microbiota were linked to worse RA conditions. Our study provides new insights into the bi-directional relationship between periodontitis and RA and suggest that monitoring the periodontal health of RA patients is particularly important.
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Affiliation(s)
- Jôice Dias Corrêa
- Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gabriel R Fernandes
- Oswaldo Cruz Fundation, René Rachou Research Center, Belo Horizonte, MG, Brazil
| | | | | | - Janine Mayra Silva
- Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Fernando Q Cunha
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - E Xiao
- Penn Dental School, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Eugene J Leys
- The Ohio State University, College of Dentistry, Columbus, OH, USA
| | | | - Dana T Graves
- Penn Dental School, University of Pennsylvania, Philadelphia, PA, USA.
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Loutan L, Alpizar-Rodriguez D, Courvoisier DS, Finckh A, Mombelli A, Giannopoulou C. Periodontal status correlates with anti-citrullinated protein antibodies in first-degree relatives of individuals with rheumatoid arthritis. J Clin Periodontol 2019; 46:690-698. [PMID: 31025368 DOI: 10.1111/jcpe.13117] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022]
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.
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Affiliation(s)
- Lucie Loutan
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Andrea Mombelli
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
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Kriauciunas A, Gleiznys A, Gleiznys D, Janužis G. The Influence of Porphyromonas Gingivalis Bacterium Causing Periodontal Disease on the Pathogenesis of Rheumatoid Arthritis: Systematic Review of Literature. Cureus 2019; 11:e4775. [PMID: 31363455 PMCID: PMC6663055 DOI: 10.7759/cureus.4775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Periodontal pathologies are highly widespread throughout the world. Epidemiological studies have shown that as much as 1% of the population is suffering from periodontal disease. In recent years, there has been a growing number of studies linking these diseases with autoimmune diseases, especially with rheumatoid arthritis. This literature review evaluates changes in the relationship between periodontal pathologies caused by the bacterium Porphyromonas gingivalis and rheumatoid arthritis. The systematic review of the literature was performed according to the PRISMA analysis protocol. The review was performed with articles from the PubMed database. Searched articles were not older than 5 years. Only full texts and research performed with people were selected. A total of 56 results were received. A review and analysis of their full texts have been carried out and 10 articles were selected according to the established criteria. They were analyzed and results were presented. The results obtained from the literature were based on the influence of Porphyromonas gingivalis on the pathogenesis of rheumatoid arthritis. In the literature, the activity of this bacterium is explained by the analysis of its enzyme peptidylarginine deiminase and its principle of action. Studies have also been found to prove the presence of Porphyromonas gingivalis not only in the oral cavity but its DNA is also found in synovial fluid and plasma. In the researched articles, direct links between Porphyromonas gingivalis and rheumatoid arthritis have led doctors to draw attention to patients' oral hygiene and the condition of parodentium, as this may be the cause of autoimmune lesions. Treatment of periodontal disease will not only help maintain a healthy oral cavity but prevent the spread of bacteria to the surrounding tissues.
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Affiliation(s)
- Albertas Kriauciunas
- Dental and Maxillofacial Orthopedics, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Alvydas Gleiznys
- Dental and Maxillofacial Orthopedics, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Darius Gleiznys
- Dental and Maxillofacial Orthopedics, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Gintaras Janužis
- Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, LTU
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43
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Radwan-Oczko M, Duś-Ilnicka I, Richards P, Thomsen AM, Rasmussen C. Rheumatoid arthritis patients' oral health and disease activity. Int J Rheum Dis 2019; 22:1538-1543. [PMID: 31062938 DOI: 10.1111/1756-185x.13590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/25/2019] [Accepted: 04/01/2019] [Indexed: 01/22/2023]
Abstract
AIM Rheumatoid arthritis (RA) and periodontal diseases (PD) are common chronic, inflammatory, destructive and progressive diseases that may have similar pathophysiological mechanisms and risk factors. RA affects more than 1.5% of the world's population, with a higher percentage of females than males. PD is present in around 20% of the population and has multifactorial etiology. The purpose of this study is to describe patients' self-reported oral health and the association with RA disease activity. METHOD Three hundred patients under treatment for RA from the Division of Rheumatology, Clinical Medicine, North Jutland Region Hospital, Hjørring, Denmark and were eligible for the study. Questionnaires were emailed to the patients and 164 completed answers were received. RESULTS The mean age of the group of 164 patients (61% female) was 65 ± 11 years. The average value of Disease Activity Score of 28 joints was 2.31 ± 0.83. Only 12% of responders were active smokers. Patients estimated their status of their teeth and gingiva respectively as poor in 13% and 11% of cases, good, in 46% and 49%, and excellent, both as 40%. Spontaneous and/or provoked gingival bleeding were experienced by 15% and 49% of patients. Only 14% of patients declared feelings of loose or movable teeth and 10% declared difficulties in biting or chewing. CONCLUSIONS The status of oral cavity reported by Danish patients indicates a significant proportion with symptoms of gingival/periodontal disease, which may negatively influence RA activity and disease management. Cooperation between rheumatologists and dentists is important in oral health management in periodontal inflammation.
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Affiliation(s)
| | - Irena Duś-Ilnicka
- Department and Division of Oral Pathology, Wrocław Medical University, Wrocław, Poland
| | - Pamela Richards
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Marie Thomsen
- Rheumatology Department, Clinic of Medicine, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Claus Rasmussen
- Rheumatology Department, Clinic of Medicine, North Denmark Regional Hospital, Hjoerring, Denmark
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Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, Sánchez-Alonso F, Sánchez-Piedra C, González-Dávila E, Díaz-González F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther 2019; 21:27. [PMID: 30658685 PMCID: PMC6339403 DOI: 10.1186/s13075-019-1808-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/02/2019] [Indexed: 01/07/2023] Open
Abstract
Background A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity. Methods This case–control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR). Results A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02–70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24–5.74, p = 0.012). Conclusion A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity. Electronic supplementary material The online version of this article (10.1186/s13075-019-1808-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Mariano Sanz
- Grupo de Investigación de Etiología y Tratamiento de las Enfermedades Periodontales (ETEP), Facultad de Odontología, Universidad Complutense, Madrid, Spain
| | | | | | - Enrique González-Dávila
- Departamento de Estadística e Investigación Operativa, Universidad de La Laguna, S/C de Tenerife, La Laguna, Spain
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain. .,Departamento de Medicina, Facultad de Medicina, Calle Ofra s/n 38320, La Laguna, Spain.
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45
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Dillon CF, Weisman MH. US National Health and Nutrition Examination Survey Arthritis Initiatives, Methodologies and Data. Rheum Dis Clin North Am 2018; 44:215-265. [PMID: 29622293 DOI: 10.1016/j.rdc.2018.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The US National Health and Nutrition Examination Survey (NHANES) has collected population-based, nationally representative examination, laboratory, and radiographic data for arthritis and musculoskeletal diseases for more than 50 years. The resulting body of data and publications are substantial, yet much data remain unpublished. This review provides a basic understanding of the design and capabilities of the NHANES survey, reviewing the major accomplishments in the area of arthritis and musculoskeletal diseases. Currently available US National Health and Nutrition Examination Survey arthritis-related datasets are identified. Guidelines for using these data, and opportunities for data analysis and designing future studies are presented.
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Affiliation(s)
| | - Michael H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center, 1545 Calmar Court, Los Angeles, CA 90024, USA
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Niccoli L, Nannini C, Blandizzi C, Mantarro S, Mosca M, Di Munno O, Goletti D, Benucci M, Gobbi FL, Cassarà E, Kaloudi O, Cantini F. Personalization of biologic therapy in patients with rheumatoid arthritis: less frequently accounted choice-driving variables. Ther Clin Risk Manag 2018; 14:2097-2111. [PMID: 30498353 PMCID: PMC6207089 DOI: 10.2147/tcrm.s175772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective To propose appropriate statements that drive the choice of biologic therapies in patients with rheumatoid arthritis (RA), factoring in their impact on the following issues: anti-drug antibody (ADAb) formation, suspicion and management of infections, lupus-like syndrome (LLS), effects on bone mass and sexual sphere, and relationship between RA and periodontal disease (PD). Methods An overview of existing evidence was undertaken by an expert panel on behalf of the Italian board for the TAilored BIOlogic therapy (ITABIO). Data were extracted from controlled trials, national registries, national health care databases, post-marketing surveys, and, when required by the paucity of controlled studies, from open-label clinical series. Anti-tumor necrosis factor (anti-TNF) and non-anti-TNF-targeted biologics approved for RA were investigated. Results ADAb formation is chiefly associated with anti-TNFs, and it is reduced by combination therapy with methotrexate. To date, ADAb titration is not advisable for clinical practice, and, in case of anti-TNF secondary failure, a non-anti-TNF biologic is indicated. LLS is observed in anti-TNF receivers and, in most cases, resolves without anti-TNF withdrawal. A non-anti-TNF biologic is advisable in patients experiencing LLS. Non-anti-TNFs demonstrated a low or absent infection risk and are preferable in patients with comorbidities. Due to their positive effects on bone mass, anti-TNFs are indicated in women at osteoporosis risk, whereas non-anti-TNF have been poorly investigated. The emerging evidence of the relationship between RA and PD and the effects on anti-TNF efficacy should lead clinicians to consider the periodontal status in RA patients. Anti-TNFs may exert a positive effect on fertility and sexuality, and clinicians should explore these aspects in RA patients. Conclusion The optimization of biologic therapies by taking into proper account the above issues would improve patient outcomes.
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Affiliation(s)
- Laura Niccoli
- Department of Rheumatology, Hospital of Prato, Prato, Italy,
| | | | - Corrado Blandizzi
- Section of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefania Mantarro
- Section of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ombretta Di Munno
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases, Rome, Italy
| | | | | | | | - Olga Kaloudi
- Department of Rheumatology, Hospital of Prato, Prato, Italy,
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47
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Ayala-Herrera JL, Abud-Mendoza C, Gonzalez-Amaro RF, Espinosa-Cristobal LF, Martínez-Martínez RE. Distribution of Porphyromonas gingivalis fimA genotypes in patients affected by rheumatoid arthritis and periodontitis. Acta Odontol Scand 2018; 76:520-524. [PMID: 29726309 DOI: 10.1080/00016357.2018.1469788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine and compare the distribution of Porphyromonas gingivalis fimA genotypes in patients affected by Rheumatoid arthritis (RA) and periodontitis (PE). MATERIALS AND METHODS This study involved 394 subjects divided into four groups, RA, PE, RA and PE and healthy subjects. PE was diagnosed by using clinical attachment loss (CAL) and probing depth (PD) indexes. Presence of P. gingivalis and its genotypes was identified by polymerase chain reaction in subgingival biofilm. RESULTS P. gingivalis was more frequent in patients with RA (82.69%), and fimA II genotype was the most frequent in all groups, especially in PE/RA (76.71%). There was statistical difference (p < .05) regarding the frequency of P. gingivalis genotypes such as fimA Ib, II and III. CONCLUSIONS Distribution of P. gingivalis fimA II genotypes was different among groups, it could play a critical role in the presence of PE in RA patients.
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Affiliation(s)
- José Luis Ayala-Herrera
- Doctorado en Ciencias Biomedicas Basicas, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Dental Science with Specialization in Advanced General Dentistry Program, San Luis Potosi University, San Luis Potosi, Mexico
| | - Carlos Abud-Mendoza
- Regional Unit of Rheumatology and Osteoporosis at Central Hospital “Dr. Ignacio Morones Prieto”, Faculty of Medicine, San Luis Potosi University, San Luis Potosi, Mexico
| | - Roberto F. Gonzalez-Amaro
- Doctorado en Ciencias Biomedicas Basicas, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | | | - Rita Elizabeth Martínez-Martínez
- Doctorado en Ciencias Biomedicas Basicas, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Dental Science with Specialization in Advanced General Dentistry Program, San Luis Potosi University, San Luis Potosi, Mexico
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48
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Ceccarelli F, Orrù G, Pilloni A, Bartosiewicz I, Perricone C, Martino E, Lucchetti R, Fais S, Vomero M, Olivieri M, di Franco M, Priori R, Riccieri V, Scrivo R, Shoenfeld Y, Alessandri C, Conti F, Polimeni A, Valesini G. Porphyromonas gingivalis in the tongue biofilm is associated with clinical outcome in rheumatoid arthritis patients. Clin Exp Immunol 2018; 194:244-252. [PMID: 30009382 DOI: 10.1111/cei.13184] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 12/24/2022] Open
Abstract
Several studies have suggested a link between human microbiome and rheumatoid arthritis (RA) development. Porphyromonas gingivalis seems involved in RA initiation and progression, as supported by the high occurrence of periodontitis. In this case-control study, we analysed tongue P. gingivalis presence and quantification in a large healthy and RA cohort. We enrolled 143 RA patients [male/female (M/F) 32/111, mean ± standard deviation (s.d.), age 57·5 ± 19·8 years, mean ± s.d. disease duration 155·9 ± 114·7 months); 36 periodontitis patients (M/F 11/25, mean ± s.d., age 56 ± 9·9 years, mean ± s.d. disease duration 25·5 ± 20·9 months); and 57 patients (M/F 12/45, mean ± s.d., age 61·4 ± 10·9 years, mean ± s.d. disease duration 62·3 ± 66·9 months) with knee osteoarthritis or fibromyalgia. All subjects underwent a standard cytological swab to identify the rate of P. gingivalis/total bacteria by using quantitative real-time polymerase chain reaction. The prevalence of P. gingivalis resulted similarly in RA and periodontitis patients (48·9 versus 52·7%, P = not significant). Moreover, the prevalence of this pathogen was significantly higher in RA and periodontitis patients in comparison with control subjects (P = 0·01 and P = 0·003, respectively). We found a significant correlation between P. gingivalis rate in total bacteria genomes and disease activity score in 28 joints (DAS28) (erythrocyte sedimentation rate) (r = 0·4, P = 0·01). RA patients in remission showed a significantly lower prevalence of P. gingivalis in comparison with non-remission (P = 0·02). We demonstrated a significant association between the percentage of P. gingivalis on the total tongue biofilm and RA disease activity (DAS28), suggesting that the oral cavity microbiological status could play a role in the pathogenic mechanisms of inflammation, leading to more active disease.
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Affiliation(s)
- F Ceccarelli
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - G Orrù
- Molecular Biology Service, University of Cagliari 'Ospedale S. Giovanni di Dio', Cagliari, Italy
| | - A Pilloni
- Odontoiatria, Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, Sapienza Università di Roma, Rome, Italy
| | - I Bartosiewicz
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - C Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - E Martino
- Odontoiatria, Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, Sapienza Università di Roma, Rome, Italy
| | - R Lucchetti
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - S Fais
- Molecular Biology Service, University of Cagliari 'Ospedale S. Giovanni di Dio', Cagliari, Italy
| | - M Vomero
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - M Olivieri
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - M di Franco
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - R Priori
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - V Riccieri
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - R Scrivo
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - Y Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center (affiliated to Tel-Aviv University), Tel-Hashomer, Israel.,Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
| | - C Alessandri
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - F Conti
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
| | - A Polimeni
- Odontoiatria, Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, Sapienza Università di Roma, Rome, Italy
| | - G Valesini
- Reumatologia, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Rome, Italy
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49
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de Pablo P. Editorial: Marginal Jawbone Loss Is Associated With the Onset of Rheumatoid Arthritis and Is Related to the Plasma Level of RANKL. Arthritis Rheumatol 2018; 70:480-483. [DOI: 10.1002/art.40436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Paola de Pablo
- University of Birmingham; Queen Elizabeth Hospital; Birmingham UK
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50
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Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis. Clin Oral Investig 2018; 23:141-151. [DOI: 10.1007/s00784-018-2420-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/13/2018] [Indexed: 12/31/2022]
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