Decreased interleukin-1beta and elastase in the gingival crevicular fluid of individuals undergoing anti-inflammatory treatment for rheumatoid arthritis

Determination of serum and gingival crevicular fluid levels of omentin in healthy and rheumatoid arthritis subjects with and without periodontitis

OBJECTIVE

The aim of this study was to assess and correlate the serum and GCF levels of omentin with the periodontal status of rheumatoid arthritis (RA) patients with and without periodontitis.

METHODS

Forty-four patients were divided into four groups: group H: 11 systemically and periodontally healthy subjects; group P: 11 systemically healthy subjects with periodontitis; group RA: 11 periodontally healthy subjects with rheumatoid arthritis and group RA + P: 11 rheumatoid arthritis subjects with periodontitis. Periodontal parameters (plaque index, modified gingival index, probing depth, and clinical attachment level) were recorded and serum and GCF samples were collected for the estimation of omentin using ELISA.

RESULTS

The mean value of plaque index, modified gingival index, probing depth, and clinical attachment level were significantly higher whereas serum and GCF omentin levels were found to be decreased in group IV when compared to the other groups. The significant correlation was found between the serum and GCF omentin levels with all the periodontal parameters.

CONCLUSION

The omentin level in serum and GCF was found to be lower in RA patients with periodontitis. It is also inversely correlated with the periodontal parameters. Thus, omentin can serve as a significant diagnostic and therapeutic tool in both periodontal and rheumatoid disease.

Local gingival crevicular fluid, synovial fluid, and circulating levels of prolactin hormone in patients with moderately active rheumatoid arthritis and stage III and IV periodontitis before and after non-surgical periodontal treatment-a controlled trial

OBJECTIVES

We aimed to investigate prolactin (PRL) levels in gingival crevicular fluid (GCF), synovial fluid, and serum in patients suffering from moderately active rheumatoid arthritis (RA) with and without periodontitis (P). Further, to evaluate the effect of non-surgical periodontal treatment on these levels compared to controls.

MATERIALS AND METHODS

Eighty subjects were divided into 4 groups: group 1: 20 patients with RA + P, group 2: 20 periodontitis patients (systemically healthy), group 3: RA patients (periodontally healthy), and group 4: healthy controls. Patients with periodontitis received scaling and root planning (SRP). PRL was measured using enzyme-linked immunosorbent assay.

RESULTS

At baseline, in GCF of RA + P group showed the highest mean PRL levels, followed by P group whereas groups 3 and 4 showed a statistically less values than the first 2 groups. Serum values showed non-significant difference between the first three groups, although higher than healthy controls. SRP reduced GCF and serum levels of PRL in both P groups as well as synovial fluid PRL in group 1. SRP caused no change in DAS scores while reduced ESR values were observed in group 1 after treatment.

CONCLUSIONS

Local GCF and synovial levels of PRL seem to be linked to the disease process of both periodontitis and rheumatoid arthritis than serum levels. SRP reduced these local levels.

CLINICAL RELEVANCE

In patients with RA and CP, local PRL seems to play a role in the association between the two conditions; further, periodontal treatment is essential to improve periodontal condition in RA patients.

TRIAL REGISTRATION

Clinicaltrials.gov. Identifier: NCT04279691.

Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case-control study

OBJECTIVES

This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1β (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels.

MATERIALS AND METHODS

Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1β, MMP-8, and sclerostin levels.

RESULTS

There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastrıcht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05).

CONCLUSION

These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS.

CLINICAL RELEVANCE

The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis.

TRIAL REGISTRATION

Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020).

Oral Microbiota: A Major Player in the Diagnosis of Systemic Diseases

The oral cavity is host to a complex and diverse microbiota community which plays an important role in health and disease. Major oral infections, i.e., caries and periodontal diseases, are both responsible for and induced by oral microbiota dysbiosis. This dysbiosis is known to have an impact on other chronic systemic diseases, whether triggering or aggravating them, making the oral microbiota a novel target in diagnosing, following, and treating systemic diseases. In this review, we summarize the major roles that oral microbiota can play in systemic disease development and aggravation and also how novel tools can help investigate this complex ecosystem. Finally, we describe new therapeutic approaches based on oral bacterial recolonization or host modulation therapies. Collaboration in diagnosis and treatment between oral specialists and general health specialists is of key importance in bridging oral and systemic health and disease and improving patients' wellbeing.

Cytokines in gingival crevicular fluid in elderly rheumatoid arthritis patients in a population-based cross-sectional study: RANTES was associated with periodontitis

Objective

We studied cytokines in gingival crevicular fluid (GCF) in a cross‐sectional population‐based cohort of rheumatoid arthritis (RA) patients ≥61 years of age with and without a diagnosis of periodontitis.

Background data

Earlier studies on cytokines in GCF in RA patients have not given clear results.

Methods

In a population‐based cross‐sectional study of patients ≥61 years of age, 233 RA patients were identified. 132 (57%) dentate RA patients participated. All participants received rheumatological and dental examinations, and had a panoramic radiograph taken. GCF was sampled on each patient. Interleukins 1‐β (IL‐1β), IL‐4, IL‐6, IL‐10, IL‐17A, tumor necrosis factor alpha (TNF‐α), interferon gamma (IFN‐γ), and chemokines RANTES/CCL5, eotaxin and monocyte chemoattractant protein (MCP‐1) were analyzed in GCF. These cytokines were stratified for periodontitis, age, gender, body mass index (BMI), smoking, and anti‐cyclic citrullinated protein (anti‐CCP) status. Binary logistic regression analyses with periodontitis as outcome were performed adjusting for the above mentioned confounding factors including anti‐rheumatic medication, disease duration and the cytokine in question.

Results

Periodontitis was diagnosed in 80/132 (61%) of study participants. The 110 RA patients not participating were older, had a higher mean erythrocyte sedimentation rate (ESR), had a higher mean DAS28ESR (Disease Activity Score 28 using ESR) and were less often on biologic treatment. Only RANTES was associated with periodontitis (p = .049, OR 1.001, 95% CI 1.000–1.002) in the binary logistic regression analyses.

Conclusion

In this population‐based elderly RA cohort, neither pro‐inflammatory nor anti‐inflammatory cytokines in GCF were clearly associated with a diagnosis of periodontitis.

Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and Potential Biological Interactions

The association between rheumatoid arthritis (RA) and periodontal disease (PD) has been the focus of numerous investigations driven by their common pathological features. RA is an autoimmune disease characterized by chronic inflammation, the production of anti-citrullinated proteins antibodies (ACPA) leading to synovial joint inflammation and destruction. PD is a chronic inflammatory condition associated with a dysbiotic microbial biofilm affecting the supporting tissues around the teeth leading to the destruction of mineralized and non-mineralized connective tissues. Chronic inflammation associated with both RA and PD is similar in the predominant adaptive immune phenotype, in the imbalance between pro- and anti-inflammatory cytokines and in the role of smoking and genetic background as risk factors. Structural damage that occurs in consequence of chronic inflammation is the ultimate cause of loss of function and disability observed with the progression of RA and PD. Interestingly, the periodontal pathogen Porphyromonas gingivalis has been implicated in the generation of ACPA in RA patients, suggesting a direct biological intersection between PD and RA. However, more studies are warranted to confirm this link, elucidate potential mechanisms involved, and ascertain temporal associations between RA and PD. This review is mainly focused on recent clinical and translational research intends to discuss and provide an overview of the relationship between RA and PD, exploring the similarities in the immune-pathological aspects and the possible mechanisms linking the development and progression of both diseases. In addition, the current available treatments targeting both RA and PD were revised.

Cytokines in gingivocrevicular fluid of rheumatoid arthritis patients: A review of the literature

Objective

Rheumatoid arthritis (RA) and periodontitis share several pathological features including bone and soft tissue destruction and high levels of circulating inflammatory proteins. Studies related to cytokines in the periodontal inflammatory exudate (gingivocrevicular fluid, GCF) of RA patients might provide insight into the association between periodontitis and RA. The aim of our study was to review the literature on cytokines in GCF of RA patients including the effect of anti‐rheumatic treatment with biological disease‐modifying anti‐rheumatic drugs (DMARDs) and periodontal treatment on these cytokines.

Materials and methods

MedLine/PubMed searches with different combinations of keywords “rheumatoid arthritis or RA” and “crevicular fluid or GCF” until June 2019 revealed 64 articles. Ten cross‐sectional observational studies and nine treatment studies fulfilled the inclusion criteria.

Results

Rheumatoid arthritis patients have increased circulating and GCF levels of pro‐inflammatory cytokines and proteins, despite anti‐rheumatic treatment with biological DMARDs. Presence of periodontitis was accompanied by higher cytokine and protein levels. Treatment of periodontitis resulted in a decrease of these levels.

Conclusion

Analysis of GCF of RA patients reveals that the relationship between periodontitis and RA is bidirectional, probably caused by a non‐specific inflammatory burden. Data for a specific relationship are barely present in GCF.

Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis: Results from a cross-sectional study

BACKGROUND

The aim of this cross-sectional study was to investigate clinical periodontal findings as well as prevalence of selected potentially periodontal pathogenic bacteria in patients with rheumatoid arthritis (RA) treated with different immunosuppressive rheumatic medications.

METHODS

One hundred sixty-eight patients with RA undergoing different immunosuppressive medications were included and divided into subgroups according to their medication, which was taken in the past 6 months, in detail, 1) non-steroidal anti-inflammatory drugs (NSAID) and glucocorticoids combined, and the following different disease modifying anti-rheumatic drugs (DMARDs): 2) methotrexate (MTX), 3) leflunomide, 4) MTX and TNF-α antagonists combined, 5) interleukin-6 (IL-6) antagonist, 6) MTX and rituximab combined, and 7) combination therapies of > 2 of these DMARDs. Periodontal examination consisted of papilla bleeding index (PBI), periodontal status with periodontal probing depth (PD), bleeding on probing (BOP), and clinical attachment loss (AL). Periodontitis was classified as none/mild, moderate, or severe. Samples obtained from gingival crevicular fluid were analyzed for presence of 11 periodontal pathogenic bacteria.

RESULTS

Patients with MTX + TNF-α antagonists therapy showed higher PBI and BOP values compared with leflunomide (P < 0.01) and higher BOP than MTX + rituximab (P = 0.02). Porphyromonas gingivalis (P < 0.01), Treponema denticola (P < 0.01), Fusobacterium nodatum (P = 0.02) and Capnocytophaga species (P = 0.05) was associated with medication subgroup, whereby post hoc testing confirmed singular differences for several medication subgroups.

CONCLUSIONS

RA medication is associated with periodontal inflammation, without differences in periodontal disease severity. Thereby, combination of MTX + TNF-α shows an increased potential to periodontal inflammation. Additionally, several differences in prevalence of selected bacteria were detected.

Effects of Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Response to Periodontal Treatment in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory diseases and periodontitis is known to be more common and more severe in patients with RA. Based on a paucity of studies about the relationship between common conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and periodontitis, this prospective study aimed to evaluate the adjunctive effect of csDMARDs on response to nonsurgical periodontal treatment in patients with RA. Thirty-two patients with RA (RA group) and 32 systemically healthy patients (control group) with periodontitis were included in this study. The RA group patients were treated with csDMARDs, such as methotrexate, hydroxychloroquine, and sulfasalazine. Conventional nonsurgical periodontal treatment with scaling and root planing was performed in both groups. The extent and severity of periodontitis were evaluated by plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) at baseline and 4 weeks after periodontal treatment. There was no statistically significant difference of periodontal parameters between the RA and control groups at baseline. Four weeks after scaling and root planing, PD reduction, and CAL gain were higher in the RA group treated with csDMARDs compared to the control group, and the difference was statistically significant (P = 0.006 and 0.003, respectively). A post hoc analysis of the RA group showed no statistically significant difference on the response to nonsurgical periodontal treatment in multiple csDMARDs therapy and addition of NSAIDs and/or steroids to csDMARDs. In patients with RA, csDMARDs showed beneficial effect on periodontal clinical parameters following the nonsurgical periodontal treatment.

Comparison of serum tumor necrosis factor-α levels in rheumatoid arthritis individuals with and without chronic periodontitis: A biochemical study

Background

Tumor necrosis factor-alpha (TNF-α) is indicated to play a major function in chronic inflammatory disorders.

Objective

To assess and compare the cytokine level (TNF-α) in the serum of chronic periodontitis (CP), rheumatoid arthritis (RA), RA with CP, and healthy volunteers.

Materials and Methods

This original research was carried out on 80 participants, divided into Group-I 20 RA patients, Group-II 20 CP patients, Group III 20 RA with CP (RA + CP), and Group IV 20 healthy volunteers. Clinical periodontal and rheumatological parameters were assessed in all the four groups. Blood serum samples have been collected from all individuals and investigated for levels of TNF-α by mean of enzyme-linked immunosorbent assay.

Results

TNF-α level were remarkably elevated in the RA+CP group (30.5±2.2) followed by RA group (17.9 ± 3.6), and CP group (11.9 ± 0.96) when compared with the controls (5.5 ± 3.3). The results showed a statistical significance of P < 0.001. Correlation was not observed on comparision of clinical periodontal parameters and Rheumatological parameters with TNF-α levels.

Conclusion

The outcome of this present research revealed the presence of higher levels of TNF-α in individuals with RA with CP in our samples.

Identification of Gingival Crevicular Fluid Sampling, Analytical Methods, and Oral Biomarkers for the Diagnosis and Monitoring of Periodontal Diseases: A Systematic Review

Background. Several studies in the last decades have focused on finding a precise method for the diagnosis of periodontal disease in its early stages. Aim. To evaluate from current scientific literature the most common and precise method for gingival crevicular fluid (GCF) sample collection, biomarker analytical methods, and the variability of biomarker quantification, even when using the same analytical technique. Methodology. An electronic search was conducted on in vivo studies that presented clinical data on techniques used for GCF collection and biomarker analysis. Results. The results showed that 71.1%, 24.7%, and 4.1% of the studies used absorption, microcapillary, and washing techniques, respectively, in their gingival crevicular fluid collection. 73.1% of the researchers analyzed their samples by using enzyme-linked immunosorbent assay (ELISA). 22.6%, 19.5%, and 18.5% of the researchers included interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), and tumor necrosis factor-alpha (TNF-α), respectively, in their studies as biomarkers for periodontal disease. Conclusion. IL-1β can be considered among the most common biomarkers that give precise results and can be used as an indicator of periodontal disease progression. Furthermore, paper strips are the most convenient and accurate method for gingival crevicular fluid collection, while enzyme-linked immunosorbent assay can be considered the most conventional method for the diagnosis of biofluids.

Elastase and metalloproteinase-9 concentrations in saliva in patients with chronic periodontitis

Elastase and metalloproteinase-9 (MMP-9) are two of numerous proteolytic enzymes released by neutrophilic granulocytes in the course of periodontitis. The aim of the study was to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis compared to healthy individuals.

The enzyme-linked immunosorbent assay method was employed to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis and with pocket depth (PD) ≥ 6 mm and PD < 6 mm, as well as in saliva of healthy individuals. Significantly higher concentrations of elastase and MMP-9 were observed in patients with periodontitis compared to healthy individuals (p < 0.01). Also a significant difference in elastase concentration in saliva was observed between the PD ≥ 4 mm and PD < 6 mm groups and between the PD ≥ 6 mm and control groups, and statistically significant differences in MMP-9 concentrations between the PD ≥ 6 mm and control groups. No statistically significant differences were observed between the PD < 6 mm and control groups for elastase concentrations in saliva as well as between the PD ≥ 6 mm and PD < 6 mm groups, and also between the PD < 6 mm and control groups for MMP-9 concentrations in saliva. Elastase and MMP-9 concentrations in saliva can be considered as biochemical indicators of severity of periodontitis.

Cytokine profile in the gingival crevicular fluid of rheumatoid arthritis patients with chronic periodontitis

The aim was to assess the cytokine profile in the gingival crevicular fluid (GCF) of rheumatoid arthritis (RA) patients with chronic periodontitis (CP). Databases were searched from 1991 to August 2013 using a combination of various keywords. Eight studies were included. The GCF concentrations of interleukin (IL)-1β, IL-4, IL-10, matrix metalloproteinase (MMP)-8, MMP-13 and tumor necrosis factor-alpha (TNF-α) were reported to be higher in patients with RA than in healthy controls (HC) without CP. In one study, TNF-α levels in GCF were significantly higher in HC than in RA patients receiving anti-TNF-α therapy. One study reported no significant difference in GCF TNF-α levels among RA patients and HC regardless of anti-TNF-α therapy. One study reported no difference in IL-1β and prostaglandin E2 levels among RA patients and HC with CP. Raised levels of proinflammatory cytokines are exhibited in the GCF of RA patients with CP.

Preventive and therapeutic anti-TNF-α therapy with pentoxifylline decreases arthritis and the associated periodontal co-morbidity in mice

AIMS

The association between rheumatoid arthritis (RA) and periodontal disease (PD) has long been studied and some reports suggest that treating RA may improve the associated PD, and vice versa. This study aimed to evaluate the effects of an anti-tumor necrosis factor (TNF)-α therapy with pentoxifylline (PTX) in an experimental model of RA-associated PD.

MAIN METHODS

Male C57BL/6 mice were subjected to chronic antigen-induced arthritis (AIA) and daily treated with PTX (50mg/kg, i.p.) using preventive (Pre-PTX) or therapeutic (The-PTX) strategies. Fourteen days after the antigen challenge, mice were euthanized and knee joints, maxillae and serum were collected for microscopic and/or immunoenzymatic analysis.

KEY FINDINGS

AIA triggered significant leukocyte recruitment to the synovial cavity, tissue damage and proteoglycan loss in the knee joint. Pre-PTX and The-PTX regimens decreased these signs of joint inflammation. The increased levels of TNF-α and IL-17 in periarticular tissues of AIA mice were also reduced by both PTX treatments. Serum levels of C-reactive protein, which were augmented after AIA, were reduced by the PTX regimens. Concomitantly to AIA, mice presented alveolar bone loss, and recruitment of osteoclasts and neutrophils to periodontal tissues. Pre-PTX and The-PTX prevented and treated these signs of PD. PTX treatment also decreased TNF-α and increased IL-10 expression in the maxillae of AIA mice, although it did not affect the expression of IFN-γ and IL-17.

SIGNIFICANCE

The current study shows the anti-inflammatory and bone protective effects of preventive and therapeutic PTX treatments, which decreased the joint damage triggered by AIA and the associated periodontal co-morbidity.

Periodontal therapy in chronic periodontitis lowers gingival crevicular fluid interleukin-1beta and DAS28 in rheumatoid arthritis patients

To evaluate clinical outcomes and effects of non-surgical periodontal therapy on serum, gingival crevicular fluid (GCF) interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels in chronic periodontitis patients with/without rheumatoid arthritis (RA), fifteen RA patients with chronic periodontitis (RA-P) and 15 systemically healthy non-RA chronic periodontitis patients (H-P) were recruited. Clinical periodontal recordings, GCF, and blood samples were obtained at baseline, 1, 3, and 6 months after periodontal treatment. GCF, serum IL-1β, TNF-α levels were analyzed by ELISA. Disease activity score 28 (DAS28) was used to assess RA clinical morbidity. Study groups were compared by Mann-Whitney U test. Wilcoxon test was used to compare the data at baseline, 1, 3, and 6 months after periodontal therapy within the same group. DAS28 decreased significantly after periodontal therapy in RA-P group (p < 0.01). Serum TNF-α concentrations of H-P group were significantly higher than those of RA-P group (p < 0.01), whereas IL-1β levels were similar. No significant change was observed in serum levels of these cytokines after periodontal therapy. GCF IL-1β amounts decreased significantly in both groups following treatment (p < 0.01). At 6-months, H-P GCF IL-1β concentrations were significantly lower than baseline. DAS28 and GCF IL-1β correlated with clinical periodontal indices (p < 0.01). Significant decreases in DAS28 and GCF IL-1β amounts after periodontal treatment suggest that periodontal therapy synergizes with systemic RA therapy to improve RA status.

Rheumatoid arthritis in the elderly and its relationship with periodontitis: a review

Periodontitis and rheumatoid arthritis are chronic inflammatory diseases commonly seen in the elderly. It has been proposed that the two conditions are interrelated and influence the severity of each other. Recently, the role of Porphyromonas gingivalis, a periodontopathogen, has been explained in the pathogenesis and progression of rheumatoid arthritis. It can be inferred from the present review that the two conditions share a common pathobiology, genetics and environmental risk factors. Furthermore, a thorough understanding of the aforementioned mechanisms might enable the development of conjoint treatment modalities beneficial in treating the geriatric population afflicted by both the disorders.

Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis

BACKGROUND

Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA.

METHODS

A full-mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age-, sex-, and smoking-matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high-sensitivity C-reactive protein (hsCRP), rheumatoid factor, and anti-citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses.

RESULTS

No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti-inflammatory drugs, whereas none of the controls used such drugs.

CONCLUSION

Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.

Proinflammatory and anti-inflammatory cytokines in gingival crevicular fluid and serum of patients with rheumatoid arthritis and patients with chronic periodontitis

BACKGROUND

The aim of this study is to evaluate proinflammatory and anti-inflammatory cytokine levels in gingival crevicular fluid (GCF) and serum of rheumatoid arthritis (RA) and chronic periodontitis (CP) patients to assess whether cytokine profiles distinguish patients with RA and patients with CP while using healthy patients as background controls.

METHODS

A total of 49 patients, 17 patients with RA (three males and 14 females; mean age: 47.82 ± 10.74 years), 16 patients with CP (10 males and six females; mean age: 44.00 ± 7.00 years), and 16 controls (eight males and eight females; mean age: 28.06 ± 6.18 years) were enrolled. Patients with RA were under the supervision of rheumatologists; 15 of the patients with RA were being treated with methotrexate-sulfasalazine combined therapy, and two of the patients were being treated with leflunomid therapy. Periodontal parameters (plaque index, gingival index, probing depth, and clinical attachment level) were recorded. Interleukin (IL)-1β, IL-4, IL-10, and tumor necrosis factor-α (TNF-α) were determined in GCF and IL-1β and IL-10 in serum by enzyme-linked immunosorbent assay.

RESULTS

There were significant differences found among RA, CP, and control groups for all periodontal parameters (P <0.05). The total amount and concentration of GCF IL-1 β, IL-4, IL-10, and TNF-α were similar in RA and CP patients (P >0.05). Although the total amount and concentration of serum IL-10 was not significantly different among the groups (P >0.05), serum IL-1β was significantly lower in the RA group compared to CP patients and controls and was higher in GCF of the RA group compared to the CP group.

CONCLUSIONS

Although clinical periodontal disease parameters indicated more severe periodontal disease in CP compared to RA patients, immunologic evaluation did not reveal consistent results regarding proinflammatory and anti-inflammatory cytokine levels. This might be a result of the use of non-steroidal anti-inflammatory drugs and rheumatoid agents by patients with RA.

Effect of anti-rheumatic agents on periodontal parameters and biomarkers of inflammation: a systematic review and meta-analysis

PURPOSE

Anti-rheumatic agents target common molecular pathways of inflammation in rheumatoid arthritis (RA) and periodontitis. The purpose of this study was to determine the relative effect of anti-rheumatic agents on the levels of inflammatory biomarkers and periodontal inflammation in RA patients with periodontitis.

METHODS

A systematic review and meta-analysis were conducted of studies comparing periodontal parameters of inflammation, such as bleeding on probing, and biomarkers of inflammation in RA patients with periodontitis and healthy adults with and without periodontitis. The search included the electronic databases MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar, inclusive through October 2011, with no language restrictions. Hand searches were conducted of the bibliographies of related journals and systematic reviews. Observational and interventional studies assessing the effects of antirheumatic therapy qualified for inclusion. Two reviewers performed independent data extraction and risk-of-bias assessment. Of the 187 identified publications, 13 studies fulfilled the inclusion criteria.

RESULTS

When compared to healthy adults without periodontitis, RA subjects were found to have significantly higher levels of bleeding on probing and limited evidence of higher levels of interleukin-1β and tumor necrosis factor-α (TNF-α) in gingival crevicular fluid and saliva. No consistent differences were found in periodontal parameters and inflammatory biomarkers between RA subjects and adults with periodontitis. Studies evaluating the effect of anti-TNF-α therapy in RA subjects with periodontitis have yielded inconsistent results.

CONCLUSIONS

There are limited data, however, to suggest that anti-TNF-α agents can reduce local production of inflammatory cytokines and periodontal inflammation in RA patients with periodontitis.

Rheumatoid arthritis and periodontitis - inflammatory and infectious connections. Review of the literature

An association between oral disease/periodontitis and rheumatoid arthritis (RA) has been considered since the early 1820s. The early treatment was tooth eradication. Epidemiological studies suggest that the prevalence of RA and periodontitis may be similar and about 5% of the population are aged 50 years or older. RA is considered as an autoimmune disease whereas periodontitis has an infectious etiology with a complex inflammatory response. Both diseases are chronic and may present with bursts of disease activity. Association studies have suggested odds ratios of having RA and periodontitis varying from 1.8:1 (95% CI: 1.0–3.2, NS) to 8:1 (95% CI: 2.9–22.1, p<0.001). Genetic factors are driving the host responses in both RA and periodontitis. Tumor necrosis factor-α, a proinflammatory cytokine, regulates a cascade of inflammatory events in both RA and periodontitis. Porphyromonas gingivalis is a common pathogen in periodontal infection. P. gingivalis has also been identified in synovial fluid. The specific abilities of P. gingivalis to citrullinate host peptides by proteolytic cleavage at Arg-X peptide bonds by arginine gingipains can induce autoimmune responses in RA through development of anticyclic citrullinated peptide antibodies. In addition, P. gingivalis carries heat shock proteins (HSPs) that may also trigger autoimmune responses in subjects with RA. Data suggest that periodontal therapies combined with routine RA treatments further improve RA status.

Experimental arthritis triggers periodontal disease in mice: involvement of TNF-α and the oral Microbiota

Rheumatoid arthritis (RA) and periodontal disease (PD) are prevalent chronic inflammatory disorders that affect bone structures. Individuals with RA are more likely to experience PD, but how disease in joints could induce PD remains unknown. This study aimed to experimentally mimic clinical parameters of RA-induced PD and to provide mechanistic findings to explain this association. Chronic Ag-induced arthritis (AIA) was triggered by injection of methylated BSA in the knee joint of immunized mice. Anti-TNF-α was used to assess the role of this cytokine. Intra-articular challenge induced infiltration of cells, synovial hyperplasia, bone resorption, proteoglycan loss, and increased expression of cytokines exclusively in challenged joints. Simultaneously, AIA resulted in severe alveolar bone loss, migration of osteoclasts, and release of proinflammatory cytokines in maxillae. Anti-TNF-α therapy prevented the development of both AIA and PD. AIA did not modify bacterial counts in the oral cavity. PD, but not AIA, induced by injection of Ag in immunized mice was decreased by local treatment with antiseptic, which decreased the oral microbiota. AIA was associated with an increase in serum C-reactive protein levels and the expression of the transcription factors RORγ and Foxp3 in cervical lymph nodes. There were higher titers of anti-collagen I IgG, and splenocytes were more responsive to collagen I in AIA mice. In conclusion, AIA-induced PD was dependent on TNF-α and the oral microbiota. Moreover, PD was associated with changes in expression of lymphocyte transcription factors, presence of anti-collagen Abs, and increased reactivity to autoantigens.

Serum cytokine and periodontal profiles in relation to disease activity of rheumatoid arthritis in Japanese adults

BACKGROUND

Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions and share many pathologic features. A similar profile of cytokines is involved in the pathogenesis of the two diseases. The relationship between the disease activity of RA and the periodontal condition remains unclear. This study examines whether the disease activity of RA affects serum cytokine and periodontal profiles.

METHODS

The study subjects consisted of 84 Japanese adults with RA and 22 race-matched control individuals. After periodontal and rheumatologic examination, the disease activity of RA was determined with the Disease Activity Score including 28 joints using C-reactive protein (DAS28-CRP). Serum levels of cytokines including interleukin (IL)-1beta, IL-6, IL-12, IL-12 p40, IL-18, and tumor necrosis factor-alpha (TNF-alpha) were determined by an enzyme-linked immunosorbent assay. High-sensitive CRP was also measured with a latex particle-enhanced nephelometric method.

RESULTS

Of 84 patients with RA, 28 and 56 patients exhibited low and moderate to high disease activity, respectively. Serum levels of IL-6, TNF-alpha, and CRP were significantly different between the two groups (P <0.05). Additionally, a significant correlation was observed between DAS28-CRP and percentage of sites with bleeding on probing (BOP) (P = 0.008) and between serum TNF-alpha levels and percentage of sites with BOP (P = 0.01) in 56 patients with RA with moderate to high activity.

CONCLUSION

These results suggest that the disease activity of RA correlated with serum levels of IL-6, TNF-alpha, and CRP, and it might influence BOP in the patients with moderate to high disease activity.