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Kaveri A, Rajendran V, Jaishree TK, Malathi K, Kavitha M. Effect of Periodontal Therapy on Rheumatoid Disease Activity in Patients on Anti-Rheumatoid Drugs - A Prospective Study. Indian J Dent Res 2024:01363779-990000000-00019. [PMID: 39171606 DOI: 10.4103/ijdr.ijdr_535_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/09/2024] [Indexed: 08/23/2024] Open
Abstract
AIM The aim of this clinical trial rheumatoid arthritis-chronic periodontitis (RA-CP) is to assess the effect of non-surgical periodontal therapy in RA patients. MATERIALS AND METHODS Sixty RA patients taking disease-modifying anti-rheumatoid drugs (DMARD) with CP were selected from the Institute of Rheumatology, Madras Medical College, randomised into the intervention group (IG) and control group (CG). IG received non-surgical periodontal therapy after the screening visit, but CG did not receive treatment until the 3 months study period. Periodontal parameters were recorded at baseline and after 3 months for both groups. Rheumatoid Disease activity (RD activity) was assessed using disease activity score (DAS28), inclusive of tender joints count (TJC), swollen joints count (SJC), visual analog scale (VAS), and erythrocyte sedimentation rate (ESR) for both groups at baseline and after 3 months. RESULTS At the end of 3 months, IG had significant reduction in RA parameters such as tender joints count (0.0005), swollen joints count (0.0005), ESR (0.003), VAS score (0.0005), and DAS28 values (0.0005) compared to CG. Periodontal parameters at the end of 3 months were also significantly reduced in IG than in CG. CONCLUSION Non-surgical periodontal therapy might have reduced the burden of systemic inflammatory markers, thus reducing severity of RA in IG. Reduction in tenderness and swelling of joints in the upper arm might have enabled the patients in IG to perform better oral hygiene maintenance procedures.
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Affiliation(s)
- Arunachalam Kaveri
- Department of Dental Surgery, Government Pudukottai Medical College and Hospital, Tamil Nadu, India
- Department of Periodontics, Tamil Nadu Govt. Dental College and Hospital, Tamil Nadu, India
| | - Velayudham Rajendran
- Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Govt. General Hospital, Chennai, Tamil Nadu, India
- Institute of Internal Medicine, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | | | - Krishnamoorthy Malathi
- Department of Periodontics, Tamil Nadu Govt. Dental College and Hospital, Tamil Nadu, India
| | - Mohanasundaram Kavitha
- Institute of Rheumatology, Madras Medical College and Rajiv Gandhi Govt General Hospital, Chennai, Tamil Nadu, India
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Xie Y, Chen S, Sheng L, Sun Y, Liu S. A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues. Aging Dis 2023:AD.2022.1224. [PMID: 37163430 PMCID: PMC10389823 DOI: 10.14336/ad.2022.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/24/2022] [Indexed: 05/12/2023] Open
Abstract
Aging is accompanied by physical dysfunction and physiologic degeneration that occurs over an individual's lifetime. Human teeth, like many other organs, inevitably undergo chronological aging and age-related changes throughout the lifespan, resulting in a substantial need for preventive, restorative as well as periodontal dental care. This is particularly the case for seniors at 65 years of age and those older but economically disadvantaged. Dental aging not only interferes with normal chewing and digestion, but also affects daily appearance and interpersonal communications. Further dental aging can incur the case of multiple disorders such as oral cancer, encephalitis, and other systemic diseases. In the next decades or even hundreds of years, the proportion of the elderly in the global population will continue to rise, a tendency that attracts increasing attention across multiple scientific and medical disciplines. Dental aging will bring a variety of problems to the elderly themselves and poses serious challenges to the medical profession and social system. A reduced, but functional dentition comprising 20 teeth in occlusion has been proposed as a measurement index of successful dental aging. Healthy dental aging is critical to healthy aging, from both medical and social perspectives. To date, biomedical research on the causes, processes and regulatory mechanisms of dental aging is still in its infancy. In this article, updated insights into typical manifestations, associated pathologies, preventive strategies and molecular changes of dental aging are provided, with future research directions largely projected.
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Affiliation(s)
- Yajia Xie
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Lu Sheng
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yu Sun
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
- Department of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, Shandong, China
- Department of Medicine and VAPSHCS, University of Washington, Seattle, WA 98195, USA
| | - Shangfeng Liu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
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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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4
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Mosaddad SA, Mahootchi P, Safari S, Rahimi H, Aghili SS. Interactions between systemic diseases and oral microbiota shifts in the aging community: A narrative review. J Basic Microbiol 2023. [PMID: 37173818 DOI: 10.1002/jobm.202300141] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
As a gateway to general health and a diverse microbial habitat, the oral cavity is colonized by numerous microorganisms such as bacteria, fungi, viruses, and archaea. Oral microbiota plays an essential role in preserving oral health. Besides, the oral cavity also significantly contributes to systemic health. Physiological aging influences all body systems, including the oral microbial inhabitants. The cited effect can cause diseases by forming dysbiotic communities. Since it has been demonstrated that microbial dysbiosis could disturb the symbiosis state between the host and the resident microorganism, shifting the condition toward a more pathogenic one, this study investigated how the oral microbial shifts in aging could associate with the development or progression of systemic diseases in older adults. The current study focused on the interactions between variations in the oral microbiome and prevalent diseases in older adults, including diabetes mellitus, Sjögren's syndrome, rheumatoid arthritis, pulmonary diseases, cardiovascular diseases, oral candidiasis, Parkinson's disease, Alzheimer's disease, and glaucoma. Underlying diseases can dynamically modify the oral ecology and the composition of its resident oral microbiome. Clinical, experimental, and epidemiological research suggests the associations of systemic disorders with bacteremia and inflammation after oral microbial changes in older adults.
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Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pegah Mahootchi
- Department of Oral and Maxillofacial Diseases, School of Dentistry, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Sajedeh Safari
- Department of Prosthodontics, Islamic Azad University, Tehran, Iran
| | - Hussein Rahimi
- Student Research Committee, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Ahmadi P, Mahmoudi M, Kheder RK, Faraj TA, Mollazadeh S, Abdulabbas HS, Esmaeili SA. Impacts of Porphyromonas gingivalis periodontitis on rheumatoid arthritis autoimmunity. Int Immunopharmacol 2023; 118:109936. [PMID: 37098654 DOI: 10.1016/j.intimp.2023.109936] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
In RA patients' synovial sites, citrullinated RA-related antigens such as type II collagens, fibrin (ogen), vimentin, and α-enolase could be targeted by ACCPAs. Since ACCPA production can be initiated a long time before RA sign appearance, primary auto-immunization against these citrullinated proteins can be originated from extra-articular sites. It has been shown that there is a significant association between P. gingivalis periodontitis, anti- P. gingivalis antibodies, and RA. P. gingivalis gingipains (Rgp, Kgp) can degrade proteins such as fibrin and α-enolase into some peptides in the form of Arg in the C-terminal which is converted to citrulline by PPAD. Also, PPAD can citrullinate type II collagen and vimentins (SA antigen). P. gingivalis induces inflammation and chemoattraction of immune cells such as neutrophils and macrophages through the increase of C5a (gingipain C5 convertase-like activity) and SCFA secretion. Besides, this microorganism stimulates anoikis, a special type of apoptosis, and NETosis, an antimicrobial form of neutrophil death, leading to the release of PAD1-4, α-enolase, and vimentin from apoptotic cells into the periodontal site. In addition, gingipains can degrade macrophages CD14 and decrease their ability in apoptotic cell removal. Gingipains also can cleave IgGs in the Fc region and transform them into rheumatoid factor (RF) antigens. In the present study, the effects of P. gingivalis on rheumatoid arthritis autoimmune response have been reviewed, which could attract practical insight both in bench and clinic.
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Affiliation(s)
- Parisa Ahmadi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Immunology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Immunology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramiar Kamal Kheder
- Medical Laboratory Science Department, College of Science, University of Raparin, Rania, Sulaymaniyah, Iraq; Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq
| | - Tola Abdulsattar Faraj
- Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq; Department of Basic Sciences, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research center north Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hadi Sajid Abdulabbas
- Continuous Education Department, Faculty of Dentistry, University of Al-Ameed, Karbala 56001, Iraq
| | - Seyed-Alireza Esmaeili
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Immunology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Aziz J, Vaithilingam RD, Radzi Z, Rahman MT. Inflammatory Responses in Periodontitis with or Without Rheumatoid Arthritis Alter Salivary Metallothionein and Zinc. Biol Trace Elem Res 2022; 201:3162-3174. [PMID: 36094693 DOI: 10.1007/s12011-022-03416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
Periodontitis (PD) and rheumatoid arthritis (RA) are causally linked by their common inflammatory responses, yet it is largely unknown if these inflammatory responses might have an impact on salivary metallothionein (MT), zinc (Zn), and calcium (Ca) content. In this study, we analysed salivary concentrations of pro-inflammatory (IFN-γ, IL-6, and IL-17) and anti-inflammatory (IL-4 and IL-10) cytokines, as well as MT, Zn, and Ca in four groups of participants, namely control (without PD or RA, n = 21), PD (n = 21), RA (n = 21), or RAPD (n = 19). As expected, an increased amount of salivary pro-inflammatory cytokines were observed in the PD, RA, and RAPD groups. While Ca concentration was not significantly different between the groups, Zn concentration was lower in the PD, RA, and RAPD groups compared to the control group (p < 0.05). These groups also expressed higher MT/Zn ratios compared to the control group (p < 0.05). Unlike the control group, concentrations of inflammatory cytokines, MT, Zn, and Ca correlated with each other in the PD, RA, and RAPD groups (p < 0.05). Additionally, comorbidity of PD and RA appears to have a cumulative immuno-pathological impact that warrants further investigation. This study suggests that, in addition to inflammatory cytokines, salivary MT and Zn could reflect the severity of PD with or without RA, hence providing an important biomarker for diagnosis.
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Affiliation(s)
- Jazli Aziz
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Oral & Craniofacial Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rathna Devi Vaithilingam
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Zamri Radzi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Kang S, Dai A, Wang H, Ding PH. Interaction Between Autophagy and Porphyromonas gingivalis-Induced Inflammation. Front Cell Infect Microbiol 2022; 12:892610. [PMID: 35846745 PMCID: PMC9283780 DOI: 10.3389/fcimb.2022.892610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Autophagy is an immune homeostasis process induced by multiple intracellular and extracellular signals. Inflammation is a protective response to harmful stimuli such as pathogen microbial infection and body tissue damage. Porphyromonas gingivalis infection elicits both autophagy and inflammation, and dysregulation of autophagy and inflammation promotes pathology. This review focuses on the interaction between autophagy and inflammation caused by Porphyromonas gingivalis infection, aiming to elaborate on the possible mechanism involved in the interaction.
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8
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Bregaint S, Boyer E, Fong SB, Meuric V, Bonnaure-Mallet M, Jolivet-Gougeon A. Porphyromonas gingivalis outside the oral cavity. Odontology 2021; 110:1-19. [PMID: 34410562 DOI: 10.1007/s10266-021-00647-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 07/31/2021] [Indexed: 12/14/2022]
Abstract
Porphyromonas gingivalis, a Gram-negative anaerobic bacillus present in periodontal disease, is considered one of the major pathogens in periodontitis. A literature search for English original studies, case series and review articles published up to December 2019 was performed using the MEDLINE, PubMed and GoogleScholar databases, with the search terms "Porphyromonas gingivalis" AND the potentially associated condition or systemic disease Abstracts and full text articles were used to make a review of published research literature on P. gingivalis outside the oral cavity. The main points of interest of this narrative review were: (i) a potential direct action of the bacterium and not the systemic effects of the inflammatory acute-phase response induced by the periodontitis, (ii) the presence of the bacterium (viable or not) in the organ, or (iii) the presence of its virulence factors. Virulence factors (gingipains, capsule, fimbriae, hemagglutinins, lipopolysaccharide, hemolysin, iron uptake transporters, toxic outer membrane blebs/vesicles, and DNA) associated with P. gingivalis can deregulate certain functions in humans, particularly host immune systems, and cause various local and systemic pathologies. The most recent studies linking P. gingivalis to systemic diseases were discussed, remembering particularly the molecular mechanisms involved in different infections, including cerebral, cardiovascular, pulmonary, bone, digestive and peri-natal infections. Recent involvement of P. gingivalis in neurological diseases has been demonstrated. P. gingivalis modulates cellular homeostasis and increases markers of inflammation. It is also a factor in the oxidative stress involved in beta-amyloid production.
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Affiliation(s)
- Steeve Bregaint
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Emile Boyer
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Shao Bing Fong
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Vincent Meuric
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Martine Bonnaure-Mallet
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France.,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Anne Jolivet-Gougeon
- Microbiology, INSERM, INRAE, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Université de Rennes, U1241, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France. .,Teaching Hospital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes, France.
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9
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Huang Y, Zhang Z, Zheng Y, Zhao Z, Zhong Y, Zhang Q, Xia D, Ma N, Zhang L. Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis. BMC Oral Health 2021; 21:340. [PMID: 34246253 PMCID: PMC8272313 DOI: 10.1186/s12903-021-01695-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients. Methods We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method. Results Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs. Conclusions SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01695-w.
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Affiliation(s)
- Yu Huang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Zheng Zhang
- School of Medicine, Tianjin Stomatological Hospital, Nankai University, Tianjin, 300041, China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, 300041, China
| | - Youli Zheng
- Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Zhulan Zhao
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Yang Zhong
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Qingyu Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Degeng Xia
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China
| | - Ning Ma
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
| | - Li Zhang
- Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun, 130021, Jilin, China.
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10
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Ma L, Cao Z. Membrane vesicles from periodontal pathogens and their potential roles in periodontal disease and systemic illnesses. J Periodontal Res 2021; 56:646-655. [PMID: 33826135 DOI: 10.1111/jre.12884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
Periodontium is an ordered ecological system where a dynamic equilibrium exists between oral microorganisms and the host defense system, and periodontal disease occurs whenever the balance is broken. Periodontal pathogens mainly include gram-negative anaerobic bacteria and emerging gram-positive microbes, which have a large variety of virulence factors and influence disease initiation and progression. Recently, different types of bacterial membrane vesicles (MVs), formed by bubbling of membrane materials from living cells or in conditions of endolysin-triggered cell death, have gained interests as a novel virulence factor for periodontopathogens. MVs load multiple sorted cargo molecules, such as proteins, lipids, and genetic materials, and actively participate in toxin transport, signal delivery, and periodontal disease pathogenesis. Since periodontitis is recognized as a risk factor for many systemic diseases, periodontal MVs could work as a bridge for periodontal diseases and systemic illnesses. Furthermore, MVs with unique nature and advantages are promising candidates as vaccines and drug delivery vehicles. In this review, we provided an overview of different types and compositions of periodontal MVs, described their involvements in the pathogenesis of periodontitis and several general diseases, and discussed potential applications of periodontal MVs in vaccination and drug delivery.
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Affiliation(s)
- Li Ma
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengguo Cao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST KLOS) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBME), School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Abstract
OBJECTIVE The intent was to analyse the association of periodontitis with the development of rheumatoid arthritis (RA) using a representative population-based cohort and longitudinal matched-cohort design. METHODS Participants were 40 years of age or older and had not been diagnosed with RA between 2002 and 2006. Among the participants, those who were newly diagnosed with periodontitis between 2004 and 2006 (excluding cases that had already been diagnosed with periodontitis between 2002 and 2003) were allotted to the periodontitis group. Among the participants, those who had never been diagnosed with periodontitis between 2002 and 2006 formed the control group, matched by sex, age, and household income at a 1:1 ratio. From 2007 to 2018, the 2 groups (n = 691,506) were followed to monitor the development of RA. The t-test and χ2 test compared the general characteristics and health-related variables of both groups. The Kaplan-Meier method with a log-rank test was conducted to compare the incidence of RA in both groups. The hazard ratio (HR) and adjusted hazard ratio (aHR) were calculated using a Cox proportional hazard regression analysis to evaluate the risk of subsequent RA. RESULTS Univariate analysis revealed that the periodontitis group was more likely to develop RA than the control group (hazard ratio 1.10), and multivariate analysis also revealed a higher incidence risk of RA (adjusted hazard ratio 1.09) in the periodontitis group. CONCLUSIONS Our findings demonstrate that periodontitis is associated with an increased risk of developing RA.
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Interleukin-6 in Rheumatoid Arthritis. Int J Mol Sci 2020; 21:ijms21155238. [PMID: 32718086 PMCID: PMC7432115 DOI: 10.3390/ijms21155238] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
The role of interleukin (IL)-6 in health and disease has been under a lot of scrutiny in recent years, particularly during the recent COVID-19 pandemic. The inflammatory pathways in which IL-6 is involved are also partly responsible of the development and progression of rheumatoid arthritis (RA), opening interesting perspectives in terms of therapy. Anti-IL-6 drugs are being used with variable degrees of success in other diseases and are being tested in RA. Results have been encouraging, particularly when anti-IL-6 has been used with other drugs, such as metothrexate (MTX). In this review we discuss the main immunologic aspects that make anti-IL-6 a good candidate in RA, but despite the main therapeutic options available to target IL-6, no gold standard treatment has been established so far.
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Porphyromonas gingivalis, a Long-Range Pathogen: Systemic Impact and Therapeutic Implications. Microorganisms 2020; 8:microorganisms8060869. [PMID: 32526864 PMCID: PMC7357039 DOI: 10.3390/microorganisms8060869] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Periodontitis is an inflammatory disease associated with a dysbiosis of the oral flora characterized by a chronic sustained inflammation leading to destruction of tooth-supporting tissues. Over the last decade, an association between periodontitis and systemic disorders such as cardiovascular diseases, rheumatoid arthritis and obesity has been demonstrated. The role of periodontal pathogens, notably Porphyromonas gingivalis (P. gingivalis), in the onset or exacerbation of systemic diseases has been proposed. P. gingivalis expresses several virulence factors that promote its survival, spreading, and sustaining systemic inflammation. Recently, the impact of periodontitis on gut dysbiosis has also been suggested as a potential mechanism underlying the systemic influence of periodontitis. New therapeutic strategies for periodontitis and other dysbiotic conditions, including the use of beneficial microbes to restore healthy microbial flora, may pave the way to improved therapeutic outcomes and more thorough patient management.
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Lee KH, Choi YY. Rheumatoid arthritis and periodontitis in adults: Using the Korean National Health Insurance Service‒National Sample Cohort. J Periodontol 2020; 91:1186-1193. [DOI: 10.1002/jper.19-0311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Kyeong Hee Lee
- Department of Dental Hygiene College of Bioecological Health Shinhan University Uijeongbu Republic of Korea
| | - Yoon Young Choi
- Department of Dental Hygiene College of Bioecological Health Shinhan University Uijeongbu Republic of Korea
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15
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Merle CL, Hoffmann R, Schmickler J, Rühlmann M, Challakh N, Haak R, Schmalz G, Ziebolz D. Comprehensive Assessment of Orofacial Health and Disease Related Parameters in Adolescents with Juvenile Idiopathic Arthritis-A Cross-Sectional Study. J Clin Med 2020; 9:jcm9020513. [PMID: 32069957 PMCID: PMC7074230 DOI: 10.3390/jcm9020513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The aim of this cross-sectional study was to investigate oral health and functional status of adolescents with juvenile idiopathic arthritis (JIA) and its possible link to disease specific parameters. Methods: Patients with JIA were recruited (November 2012–October 2014) and disease specific information was extracted from patients’ records. Oral examination included: dental findings (decayed-, missing- and filled-teeth-index (dmf-t/DMF-T)), gingival inflammation (papilla-bleeding-index (PBI)) and periodontal screening index (PSI). Functional examination followed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Additionally, modified Helkimo’s Clinical Dysfunction Index and radiographic scoring were recorded. Results: 59 JIA patients were included. The mean dmf-t/DMF-T was 2.6. Only one patient showed no signs of gingival inflammation, while 57.6% had a maximum PSI of 2 or less. Positive functional findings were assessed clinically in more than half of the patients. Major diagnosis by RDC/TMD was osteoarthrosis. Patients with at least one positive anamnestic or clinical functional finding revealed significantly higher radiographic scores (CI = 0.440, p = 0.022). Patients with increased c-reactive-protein had a significantly higher PBI (Z = –2.118, p = 0.034) and increased radiographic scores (CI = 0.408, p = 0.043). Conclusions: Adolescents suffering from JIA show high levels of caries experience and gingival inflammation. Temporomandibular joint dysfunction is often seen in JIA patients. Consequently, special dental care programs would be recommendable.
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Affiliation(s)
- Cordula Leonie Merle
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
| | - Robin Hoffmann
- Dental Practice Pröpper, Flachsenberg, Hoffmann, 34119 Kassel, Germany;
| | - Jan Schmickler
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
| | - Michael Rühlmann
- Medical Practice for Pediatricy And Pediatric Rheumatology M. Rühlmann, 37073 Goettingen, Germany;
- Department of Pediatricy II (Pediatric Neurology), University of Goettingen, 37075 Goettingen, Germany
| | - Nadia Challakh
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (C.L.M.); (J.S.); (N.C.); (R.H.); (G.S.)
- Correspondence: ; Tel.: +49-341-97-21211
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Lorenzo D, GianVincenzo Z, Carlo Luca R, Karan G, Jorge V, Roberto M, Javad P. Oral-Gut Microbiota and Arthritis: Is There an Evidence-Based Axis? J Clin Med 2019; 8:jcm8101753. [PMID: 31652577 PMCID: PMC6832398 DOI: 10.3390/jcm8101753] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022] Open
Abstract
The gut microbiome appears to be a significant contributor to musculoskeletal health and disease. Recently, it has been found that oral microbiota are involved in arthritis pathogenesis. Microbiome composition and its functional implications have been associated with the prevention of bone loss and/or reducing fracture risk. The link between gut–oral microbiota and joint inflammation in animal models of arthritis has been established, and it is now receiving increasing attention in human studies. Recent papers have demonstrated substantial alterations in the gut and oral microbiota in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). These alterations resemble those established in systemic inflammatory conditions (inflammatory bowel disease, spondyloarthritides, and psoriasis), which include decreased microbial diversity and a disturbance of immunoregulatory properties. An association between abundance of oral Porphyromonas gingivalis and intestinal Prevotella copri in RA patients compared to healthy controls has been clearly demonstrated. These new findings open important future horizons both for understanding disease pathophysiology and for developing novel biomarkers and treatment strategies. The changes and decreased diversity of oral and gut microbiota seem to play an important role in the etiopathogenesis of RA and OA. However, specific microbial clusters and biomarkers belonging to oral and gut microbiota need to be further investigated to highlight the mechanisms related to alterations in bones and joints inflammatory pathway.
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Affiliation(s)
- Drago Lorenzo
- Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health & Microbiome, Culturomics and Biofilm related infections (MCB) Unit, "Invernizzi" Pediatric Clinical Research Center, University of Milan, 20133 Milan, Italy.
| | - Zuccotti GianVincenzo
- Department of Pediatrics, V. Buzzi Childrens' Hospital & "Invernizzi" Pediatric Clinical Research Center University of Milan, 20141 Milan, Italy.
| | - Romanò Carlo Luca
- Carlo Luca Romanò, Studio Medico Cecca-Romanò, Corso Venezia, 2, 20121 Milano, Italy.
- Romano Institute, Rruga Ibrahim Rugova, 1, 00100 Tirane, Albania.
| | - Goswami Karan
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA 89814, USA.
| | | | - Mattina Roberto
- Department of Biomedical, Surgical and Dental Science, University of Milan, 20133 Milan, Italy.
| | - Parvizi Javad
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA 89814, USA.
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Kordtabar S, Aghaie M, Fakhari E, Vakili MA. Periodontal Condition in Patients with Rheumatoid Arthritis: Effect of Anti-rheumatic Drugs. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:190-194. [PMID: 31579694 PMCID: PMC6732181 DOI: 10.30476/dentjods.2019.44914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem: Rheumatoid arthritis and periodontitis are chronic inflammatory diseases with a possible bidirectional relationship. This link may be affected by many factors like drug consumption.
Purpose: This study was designed to evaluate the periodontal condition in patients with rheumatoid arthritis, considering the effect of disease modifying anti-rheumatic drugs.
Materials and Method: This case-control study included 25 newly diagnosed rheumatoid arthritis patients with negative history of taking anti-rheumatic drugs, 25 patients who received anti-rheumatic drugs for more than three years and 50 healthy individuals as a control group. Periodontal indices, including plaque index, gingival index, probing depth, clinical attachment loss, and rheumatologic indices were recorded and compared between these groups.
Results: Rheumatoid arthritis patients were significantly more affected by periodontitis compared with healthy subjects (p= 0.006). There was no significant difference in rheumatologic
indices between patients with and without periodontitis. Clinical attachment loss in old rheumatoid arthritis patients and gingival index in newly diagnosed ones were significantly
more compared to the control group (p= 0.003 and p< 0.001 respectively). We could not find a linear relationship between the severity of rheumatoid
arthritis and chronic periodontitis (p= 0.1, r= -0.224).
Conclusion: Periodontitis and clinical attachment loss were more in patients with rheumatoid arthritis than the healthy group, especially in drug consumers. Gingival index in patients without
the history of consuming anti-rheumatic drugs was significantly higher than those who were drug consumers, indicating the effect of the medications on the signs of inflammation.
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Affiliation(s)
- Samira Kordtabar
- Dental student, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrdad Aghaie
- Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Fakhari
- Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Ali Vakili
- Health Management and Social Development Research Center, Dept. of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
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Armstrong D, Dregan A, Ashworth M, White P, McGee C, de Lusignan S. Influence of prior antibiotic use on risk of rheumatoid arthritis: case control study in general practice. Rheumatology (Oxford) 2019; 59:1281-1287. [DOI: 10.1093/rheumatology/kez452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/26/2019] [Indexed: 01/07/2023] Open
Abstract
Abstract
Objectives
To test the hypothesis that prior antibiotics influences the risk of developing RA.
Methods
A case–control study was conducted over 15 years using the UK’s Royal College of General Practitioners Research and Surveillance Centre database. The frequency and type of antibiotic prescription for patients who subsequently developed RA were compared with antibiotic prescriptions in a control group of patients who remained free of RA. Cases, defined as patients with a new diagnosis of RA made between 2006 and 2018, were matched with up to four RA-free controls on practice, age, gender and date of diagnosis. Exposure was measured by the number and type of prescriptions for antibiotics prior to the RA diagnosis or to the index date in controls.
Results
A total of 8482 patients with a new diagnosis of RA between 2006 and 2018 were compared with 22 661 controls. There was a higher likelihood of an RA diagnosis after antibiotic prescriptions within 1 year, 5 years and ever with a strong dose–response. Patients receiving >10 antibiotics in a 5 year period were more than twice as likely to receive an RA diagnosis as controls [adjusted odds ratio 2.65 (CI 2.40, 2.93)].
Conclusion
Exposure to antibiotics prior to the diagnosis was a significant risk factor for RA. This could reflect an immunological response to a compromised microbiome. Alternatively, patients with pre-symptomatic or early undiagnosed RA may have been more likely to present to their general practitioner with infections due to an unrecognized effect of RA.
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Affiliation(s)
- David Armstrong
- Department of Population Health Sciences, King’s College London
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychological, and Neurosciences, King’s College London, London
| | - Mark Ashworth
- Department of Population Health Sciences, King’s College London
| | - Patrick White
- Department of Population Health Sciences, King’s College London
| | - Chris McGee
- Department of Clinical and Experimental Medicine, Surrey University, Guildford
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, Surrey University, Guildford
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
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Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and Potential Biological Interactions. Int J Mol Sci 2019; 20:ijms20184541. [PMID: 31540277 PMCID: PMC6769683 DOI: 10.3390/ijms20184541] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/07/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
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.
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20
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Bae SC, Lee YH. Association between anti-Porphyromonas gingivalis antibody, anti-citrullinated protein antibodies, and rheumatoid arthritis : A meta-analysis. Z Rheumatol 2019; 77:522-532. [PMID: 28555277 DOI: 10.1007/s00393-017-0328-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship between anti-Porphyromonas gingivalis (anti-P. gingivalis) antibody levels and rheumatoid arthritis (RA) and its correlation with anti-citrullinated protein antibodies (ACPA). METHODS We performed a meta-analysis of studies comparing (a) anti-P. gingivalis antibody levels in RA patients and healthy controls and (b) the correlation coefficients between the anti-P. gingivalis antibody levels and ACPA in RA patients. RESULTS The study included 14 articles with 3829 RA patients and 1239 controls. Our meta-analysis showed that anti-P. gingivalis antibody levels were significantly higher in the RA group than in the control group (standardized mean difference [SMD] = 0.630, 95% CI = 0.272-0.989, p = 0.001). Subgroup analysis revealed that RA patients had significantly elevated anti-P. gingivalis antibody levels compared with healthy controls, but not compared with the non-RA control group and also not between different sample sizes. Anti-P. gingivalis antibody levels were significantly higher in the RA group than in the control group in the age-/sex-matched population, but not in the unmatched population. Anti-P. gingivalis antibody levels were significantly higher in the ACPA-positive group than in the ACPA-negative group (SMD = 0.322, 95% CI = 0.164-0.480, p = 6.4 × 10-5). Meta-analysis of the correlation coefficients showed a significant positive correlation between anti-P. gingivalis antibody levels and ACPA (correlation coefficient = 0.147, 95% CI = 0.033-0.258, p = 0.012). CONCLUSION Our meta-analysis demonstrated that anti-P. gingivalis antibody levels were significantly higher in patients with RA and they were positively correlated with ACPA.
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Affiliation(s)
- S-C Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea (Republic of)
| | - Y H Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, 02841, Seoul, Korea (Republic of).
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21
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Oral Bacteria and Intestinal Dysbiosis in Colorectal Cancer. Int J Mol Sci 2019; 20:ijms20174146. [PMID: 31450675 PMCID: PMC6747549 DOI: 10.3390/ijms20174146] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
The human organism coexists with its microbiota in a symbiotic relationship. These polymicrobial communities are involved in many crucial functions, such as immunity, protection against pathogens, and metabolism of dietary compounds, thus maintaining homeostasis. The oral cavity and the colon, although distant anatomic regions, are both highly colonized by distinct microbiotas. However, studies indicate that oral bacteria are able to disseminate into the colon. This is mostly evident in conditions such as periodontitis, where specific bacteria, namely Fusobacterium nucrelatum and Porphyromonas gingivalis project a pathogenic profile. In the colon these bacteria can alter the composition of the residual microbiota, in the context of complex biofilms, resulting in intestinal dysbiosis. This orally-driven disruption promotes aberrant immune and inflammatory responses, eventually leading to colorectal cancer (CRC) tumorigenesis. Understanding the exact mechanisms of these interactions will yield future opportunities regarding prevention and treatment of CRC.
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22
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Periodontal Health and Oral Microbiota in Patients with Rheumatoid Arthritis. J Clin Med 2019; 8:jcm8050630. [PMID: 31072030 PMCID: PMC6572048 DOI: 10.3390/jcm8050630] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 12/17/2022] Open
Abstract
This study aimed to investigate the periodontal health of patients with established rheumatoid arthritis (RA) in relation to oral microbiota, systemic and oral inflammatory mediators, and RA disease activity. Forty patients underwent full-mouth dental/periodontal and rheumatological examination, including collection of blood, saliva, gingival crevicular fluid (GCF) and subgingival plaque. Composition of plaque and saliva microbiota were analysed using 16S rRNA sequencing and levels of inflammatory mediators by multiplex-immunoassay. The majority of the patients (75%) had moderate or severe periodontitis and the rest had no/mild periodontitis. Anti-citrullinated protein antibody (ACPA) positivity was significantly more frequent in the moderate/severe periodontitis (86%) compared to the no/mild group (50%). No significance between groups was observed for RA disease duration or activity, or type of medication. Levels of sCD30/TNFRSF8, IFN-α2, IL-19, IL-26, MMP-1, gp130/sIL-6Rß, and sTNF-R1 were significantly higher in serum or GCF, and April/TNFSF13 was significantly higher in serum and saliva samples in moderate/severe periodontitis. The microbial composition in plaque also differed significantly between the two groups. In conclusion, the majority of RA patients had moderate/severe periodontitis and that this severe form of the disease was significantly associated with ACPA positivity, an altered subgingival microbial profile, and increased levels of systemic and oral inflammatory mediators.
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Chandrashekara S, Shobha V, Dharmanand BG, Jois R, Kumar S, Mahendranath KM, Haridas V, Prasad S, Singh Y, Daware MA, Swamy A, Subramanian R, Somashekar SA, Shanthappa AM, Anupama KR. Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study. Int J Rheum Dis 2019; 22:1216-1225. [PMID: 30977300 DOI: 10.1111/1756-185x.13562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 02/06/2019] [Accepted: 02/28/2019] [Indexed: 01/25/2023]
Abstract
AIM The use of healthcare resources by rheumatoid arthritis (RA) patients can be related to the presence of disease, comorbid conditions, use of steroids, and the combined use of immunosuppressants. This study evaluated the risk factors associated with infection and hospitalization in RA. METHODS This multicenter, cross-sectional study enrolled 3247 RA subjects fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria to examine the prevalence of hospitalization and episodes of documentable non-tubercular infections as a part of the "Karnataka rheumatoid arthritis comorbidity" study (KRAC). The study included 2081 subjects and 1166 were excluded due to incomplete data. Demographic, clinical and treatment variables were collected, and the events related to infections and hospitalization were extracted from the medical records. Comparative analysis and multivariate logistic regression were performed. RESULTS Around 22% of the subjects had hospitalizations and 2.9% had infections. Infections were pertaining to dental (1.3%), urinary tract (1.6%) and candidiasis (0.2%). Skin- and soft tissue-related infections were found in 1.8% and 0.3% of patients, respectively. Increased need of hospitalization in RA patients was associated with advanced age (≥60 years), lower education, family income, and longer duration of RA. Presence of comorbidity, usage of three or more disease-modifying anti-rheumatic drugs (DMARDs) and family income influenced the likelihood of infection. Dental infections were less likely in working subjects and more likely in patients with increased disease duration, higher family income, comorbidities and those between the age group 40-59 years. Urinary tract infection was associated with DMARD usage. CONCLUSION Patient-specific risk factors should be considered to improve treatment strategies and to reduce the risk of infection and hospitalization in RA patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - K R Anupama
- ChanRe Rheumatology and Immunology Centre, Bangalore, India
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24
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Abstract
The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.
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Affiliation(s)
- Goesta Rutger Persson
- Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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25
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Chen W, Zhi M, Feng Z, Gao P, Yuan Y, Zhang C, Wang Y, Dong A. Sustained co-delivery of ibuprofen and basic fibroblast growth factor by thermosensitive nanoparticle hydrogel as early local treatment of peri-implantitis. Int J Nanomedicine 2019; 14:1347-1358. [PMID: 30863065 PMCID: PMC6390857 DOI: 10.2147/ijn.s190781] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective The aims of this study were to 1) encapsulate ibuprofen (IBU) and basic fibroblast growth factor (bFGF) in a thermosensitive micellar hydrogel, 2) test the biological properties of this in situ drug delivery system, and 3) study the effect of hydrogel in promoting soft tissue healing after implant surgery and its anti-inflammatory function as an early local treatment of peri-implantitis. Materials and methods A thermosensitive micellar hydrogel was prepared from amphiphilic copolymer poly(ε-caprolactone-co-1,4,8-trioxa [4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ε-caprolactone-co-1,4,8-trioxa [4.6]spiro-9-undecanone) (PECT) nanoparticles and tested in vitro using a scanning electron microscope, rheometer, UV spectrophotometer, HPLC, and transmission electron microscope. Results The bFGF + IBU/PECT hydrogel formed a stable, water-dispersible nanoparticle core shell that was injectable at room temperature, hydrogel in situ at body temperature, and provided sustained release of both hydrophilic and hydrophobic drugs. The hydrogel promoted the proliferation and adhesion of human gingival fibroblasts, upregulated the expression of adhesion factors such as vinculin proteins, and showed anti-inflammatory properties. Conclusion In situ preparation of IBU-and bFGF-loaded PECT hydrogel represents a promising drug delivery system with the potential to provide early local treatment for peri-implantitis.
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Affiliation(s)
- Wenlei Chen
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Min Zhi
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Zujian Feng
- Department of Polymer Science and Technology and Key Laboratory of Systems Bioengineering of the Ministry of Education, School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China,
| | - Pengfei Gao
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Yuan Yuan
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Congcong Zhang
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Yonglan Wang
- Department of Periodontology, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, People's Republic of China,
| | - Anjie Dong
- Department of Polymer Science and Technology and Key Laboratory of Systems Bioengineering of the Ministry of Education, School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China,
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Kim JH, Choi IA, Lee JY, Kim KH, Kim S, Koo KT, Kim TI, Seol YJ, Ku Y, Rhyu IC, Song YW, Lee YM. Periodontal pathogens and the association between periodontitis and rheumatoid arthritis in Korean adults. J Periodontal Implant Sci 2018; 48:347-359. [PMID: 30619636 PMCID: PMC6312874 DOI: 10.5051/jpis.2018.48.6.347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose Periodontitis and rheumatoid arthritis (RA) share a similar inflammatory pathogenesis. Porphyromonas gingivalis (Pg) can induce anticyclic-citrullinated peptide autoantibodies (anti-CCP antibodies), a key factor in the development of RA. This study aimed at evaluating the relationships between the 2 diseases and identifying the clinical implications thereof, with a focus on periodontal pathogens in Korean adults. Methods A total of 260 RA patients and 86 age- and sex-matched control patients without arthritis were enrolled in this prospective cross-sectional study. Periodontal indices and the prevalence and amount of periodontal pathogens were compared between the groups. Correlations between periodontal and RA indices were examined, as were correlations between 9 periodontal pathogens and RA indices. Results The RA group had significantly higher values than the control group for all investigated periodontal indices (P<0.05) except the number of teeth. The gingival index (GI) was correlated with the disease activity score 28 (DAS28) (r=0.125, P=0.049), RA disease duration (r=0.253, P<0.001), erythrocyte sedimentation rate (ESR) (r=0.162, P=0.010), and anti-CCP antibody titer (r=0.205, P=0.004). Probing pocket depth (PPD) was correlated with ESR (r=0.139, P=0.027) and anti-Pg antibody titer (r=0.203, P=0.001). Bleeding on probing (BOP) was correlated with DAS28 (r=0.137, P=0.030), RA disease duration (r=0.202, P=0.001), ESR (r=0.136, P=0.030), anti-Pg antibody titer (r=0.177, P=0.005), and anti-CCP antibody titer (r=0.188, P=0.007). Clinical attachment level (CAL) and periodontitis severity were correlated with anti-Pg antibody titer (the former r=0.201, P=0.002; the latter r=0.175, P=0.006). The quantity of Pg was positively correlated with the serum anti-Pg antibody titer (r=0.148, P=0.020). Conclusions The GI, BOP, and PPD showed positive relationships with several RA indices. The anti-Pg antibody titer had positive relationships with PPD, BOP, CAL, and periodontitis severity. Thus, increasing values of periodontal indices could be used as a risk indicator of disease development in RA patients, and an increasing anti-Pg antibody titer could be considered as a warning sign in RA patients suffering with periodontitis.
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Affiliation(s)
- Jin-Hee Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea
| | - In Ah Choi
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Joo Youn Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Kyoung-Hwa Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yang-Jo Seol
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Young Ku
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - In-Chul Rhyu
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Moo Lee
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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27
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Chen B, Zhao Y, Li S, Yang L, Wang H, Wang T, Bin Shi, Gai Z, Heng X, Zhang C, Yang J, Zhang L. Variations in oral microbiome profiles in rheumatoid arthritis and osteoarthritis with potential biomarkers for arthritis screening. Sci Rep 2018; 8:17126. [PMID: 30459400 PMCID: PMC6244360 DOI: 10.1038/s41598-018-35473-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022] Open
Abstract
The key to arthritis management is early diagnosis and treatment to prevent further joint destruction and maximize functional ability. Osteoarthritis (OA) and rheumatoid arthritis (RA) are two common types of arthritis that the primary care provider must differentiate, in terms of diagnosis and treatment. Effective and non-invasive strategies for early detection and disease identification are sorely needed. Growing evidence suggests that RA has a correlation with oral microbiome and may be affected by its dynamic variations. There is already a study comparing oral microbiome in patients with RA and OA, however, it did not screen for potential biomarkers for arthritis. In this study, we assessed the oral microbiome in saliva samples from 110 RA patients, 67 OA patients and 155 healthy subjects, using 16S rRNA gene amplicon sequencing. The structure and differences in oral microbiome between RA, OA and healthy subjects were analyzed. Eight oral bacterial biomarkers were identified to differentiate RA from OA. This report provides proof of oral microbiota as an informative source for discovering non-invasive biomarkers for arthritis screening.
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Affiliation(s)
- Bin Chen
- College of Life Science, Shandong Normal University, Jinan, 250014, China
| | - Yan Zhao
- College of Life Science, Shandong Normal University, Jinan, 250014, China.,Shandong Medicinal and Biotechnology Centre, Shandong Academy of Medical Sciences, Jinan, 250062, China
| | - Shufeng Li
- Department of Orthopedics, Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China
| | | | - Haiying Wang
- College of Life Science, Shandong Normal University, Jinan, 250014, China
| | - Tao Wang
- Shandong Medicinal and Biotechnology Centre, Shandong Academy of Medical Sciences, Jinan, 250062, China
| | - Bin Shi
- Shandong Medicinal and Biotechnology Centre, Shandong Academy of Medical Sciences, Jinan, 250062, China
| | - Zhongtao Gai
- Shandong Children's Microbiome Center, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, 250022, China
| | - Xueyuan Heng
- Microbiological Laboratory, Department of Infection Management, Department of Neurosurgery, Lin Yi People's Hospital, Linyi, Shandong Province, 276003, China
| | - Chunling Zhang
- Qingdao Human Microbiome Center, The Affiliated Central Hospital of Qingdao University, Siliu South Road 127, Qingdao, Shandong Province, 266042, China.
| | - Junjie Yang
- College of Life Science, Qilu Normal University, Jinan, 250200, China.
| | - Lei Zhang
- College of Life Science, Shandong Normal University, Jinan, 250014, China. .,Shandong Institutes for Food and Drug Control, Jinan, 250101, China. .,Qingdao Human Microbiome Center, The Affiliated Central Hospital of Qingdao University, Siliu South Road 127, Qingdao, Shandong Province, 266042, China. .,Shandong Children's Microbiome Center, Qilu Children's Hospital of Shandong University, Jinan, Shandong Province, 250022, China. .,Microbiological Laboratory, Department of Infection Management, Department of Neurosurgery, Lin Yi People's Hospital, Linyi, Shandong Province, 276003, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Chemistry and Environment, Beihang University, Beijing, 100191, China.
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28
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Ziebolz D, Rupprecht A, Schmickler J, Bothmann L, Krämer J, Patschan D, Müller GA, Mausberg RF, Schmidt J, Schmalz G, Patschan S. Association of different immunosuppressive medications with periodontal condition in patients with rheumatoid arthritis: Results from a cross-sectional study. J Periodontol 2018; 89:1310-1317. [PMID: 29786138 DOI: 10.1002/jper.17-0616] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Annegret Rupprecht
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Jan Schmickler
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | | | | | - Daniel Patschan
- Department of Cardiology, Pulmonology, Angiology, and Nephrology, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg, Germany
| | - Gerhard A Müller
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Rainer F Mausberg
- Department of Preventive Dentistry, Periodontology, and Cariology, University Medical Center Goettingen, Goettingen, Germany
| | - Jana Schmidt
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Susann Patschan
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
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29
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Zhao X, Liu Z, Shu D, Xiong Y, He M, Xu S, Si S, Guo B. Association of Periodontitis with Rheumatoid Arthritis and the Effect of Non-Surgical Periodontal Treatment on Disease Activity in Patients with Rheumatoid Arthritis. Med Sci Monit 2018; 24:5802-5810. [PMID: 30124222 PMCID: PMC6113853 DOI: 10.12659/msm.909117] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The association of periodontitis (PD) with the prevalence of rheumatoid arthritis (RA) remains controversial. Therefore, the aim of this study was to evaluate their correlation and investigate the effects of non-surgical periodontal treatment on RA. MATERIAL AND METHODS A total of 64 patients were enrolled in this study and divided into 4 groups: 18 PD patients (PD+RA-), 18 RA patients (PD-RA+), 18 RA with PD patients (PD+RA+), and 10 healthy controls (PD-RA-). Periodontal and rheumatologic parameters were examined at baseline and 1 month following non-surgical periodontal treatment. RESULTS Our results showed that RA patients had similar periodontal status. However, patients in the PD+RA+ group had significantly higher levels of rheumatologic parameters such as C-reactive protein (CRP), anti-cyclic citrulline peptide antibody (ACPA), erythrocyte sedimentation rate (ESR), and Disease Activity Score 28 (DAS28) than those in the PD-RA+ group. In addition, non-surgical periodontal treatment was efficacious in improving rheumatologic parameters of patients in the PD+RA+ group. CONCLUSIONS The presence of PD might contribute to the progression of RA, while RA might have little effect on accelerating the development of PD. In addition, RA patients with PD receiving non-surgical periodontal treatment resulted in noteworthy improvement in the clinical outcome for RA.
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Affiliation(s)
- Xinyuan Zhao
- Department of Dentistry, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Zhongjun Liu
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Dalong Shu
- Department of Dentistry, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yanlin Xiong
- Department of Dentistry, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Minzhao He
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Shuaimei Xu
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Shanshan Si
- Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Bing Guo
- Department of Dentistry, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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30
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Abstract
Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies, specifically lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein-I antibodies. Antiphospholipid syndrome can occur on its own or in association with other autoimmune diseases, most commonly systemic lupus erythematosus (SLE). A connection between cigarette smoking and anti-phospholipid antibodies (aPL) was first reported in the late1980s. Systemic lupus erythematosus patients with aPL are more likely to be smokers than those without aPL. These patients have a particularly high frequency of vascular events. Recently, a potential link between periodontitis, tobacco, and aPL has been proposed. Research has also suggested that periodontitis and Porphyromonas gingivalis infection are associated with citrullination through the action of peptidylarginine deiminase. A strong correlation between smoking and the presence of citrillunated autoantibodies, which are characteristic of rheumatoid arthritis, has also been observed. While many studies have investigated possible links between infection and aPL in patients with autoimmune diseases, the association of smoking with aPL has not been systematically examined. The fact that both aPL and tobacco are risk factors for thrombosis has complicated efforts to evaluate these factors separately. Also, there has been great variability in measurement techniques, and laboratories lack routine methods for differentiating transient and persistent aPL; both of these factors can make interpretation of autoantibody results quite challenging. This review summarizes the clinical evidence supporting a posited link between aPL and smoking, both in patients with a systemic autoimmune disease and in patients with other medical conditions.
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Affiliation(s)
- Steven R Binder
- Clinical Diagnostics Group, Bio-Rad Laboratories, 4000 Alfred Nobel Drive 4-2115, Hercules, CA, 94547, USA.
| | - Christine M Litwin
- Medical University of South Carolina, 165 Ashley Ave, Suite 324G, MSC 908, Charleston, SC, 29425, USA
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31
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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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32
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Jeong SH, Nam Y, Jung H, Kim J, Rim YA, Park N, Lee K, Choi S, Jang Y, Kim Y, Moon JH, Jung SM, Park SH, Ju JH. Interrupting oral infection of Porphyromonas gingivalis with anti-FimA antibody attenuates bacterial dissemination to the arthritic joint and improves experimental arthritis. Exp Mol Med 2018; 50:e460. [PMID: 29568073 PMCID: PMC5898898 DOI: 10.1038/emm.2017.301] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that typically results in strong inflammation and bone destruction in the joints. It is generally known that the pathogenesis of RA is linked to cardiovascular and periodontal diseases. Though rheumatoid arthritis and periodontitis share many pathologic features such as a perpetual inflammation and bone destruction, the precise mechanism underlying a link between these two diseases has not been fully elucidated. Collagen-induced arthritis (CIA) mice were orally infected with Porphyromonas gingivalis (Pg) or Pg preincubated with an anti-FimA antibody (FimA Ab) specific for fimbriae that are flexible appendages on the cell surface. Pg-infected CIA mice showed oral microbiota disruption and increased alveolar bone loss and had synovitis and joint bone destruction. However, preincubation with FimA Ab led to a significant reduction in the severity of both oral disease and arthritis. Moreover, FimA Ab attenuated bacterial attachment and aggregation on human gingival and rheumatoid arthritis synovial fibroblasts. In addition, we discovered bacteria may utilize dendritic cells, macrophages and neutrophils to migrate into the joints of CIA mice. These results suggest that disrupting Pg fimbriae function by FimA Ab ameliorates RA.
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Affiliation(s)
- Sang Hoon Jeong
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoojun Nam
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyerin Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Juryun Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeri Alice Rim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Narae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kijun Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seungjin Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeonsue Jang
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yena Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Hoi Moon
- Department of Maxillofacial Biomedical Engineering, School of Dentistry, and Department of Life and Nanopharmaceutical Sciences, Kyung Hee University, Seoul, South Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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33
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Thilagar S, Theyagarajan R, Sudhakar U, Suresh S, Saketharaman P, Ahamed N. Comparison of serum tumor necrosis factor-α levels in rheumatoid arthritis individuals with and without chronic periodontitis: A biochemical study. J Indian Soc Periodontol 2018; 22:116-121. [PMID: 29769765 PMCID: PMC5939018 DOI: 10.4103/jisp.jisp_362_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Sivasankari Thilagar
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | | | - Uma Sudhakar
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | - Snophia Suresh
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
| | | | - Nizar Ahamed
- Department of Periodontics, Thai Moogambigai Dental College, Chennai, Tamil Nadu, India
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34
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Bautista-Molano W, van der Heijde D, Landewé R, Lafaurie GI, de Ávila J, Valle-Oñate R, Romero-Sanchez C. Is there a relationship between spondyloarthritis and periodontitis? A case-control study. RMD Open 2017; 3:e000547. [PMID: 29299339 PMCID: PMC5729302 DOI: 10.1136/rmdopen-2017-000547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/21/2023] Open
Abstract
Objective To compare the frequency and severity of periodontitis in patients with spondyloarthritis (SpA) with healthy control individuals, through the evaluation of clinical, serological and microbiological periodontal condition. Methods Patients with a diagnosis of SpA (n=78) and biological disease-modifying antirheumatic drug (bDMARD) naive fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria as well as 156 healthy controls matched for age/gender were included. Two trained and calibrated periodontologists performed the periodontal clinical assessment. The presence of periodontitis and its severity were determined according to the criteria established by the Centers for Disease Control and Prevention-American Academy of Periodontology. The clinical periodontal variables, IgG1/IgG2 antibodies against Porphyromonas gingivalis andperiodontopathic bacterial identification, were also established. Comparisons of periodontal characteristics between the patients with SpA and the control group were performed using univariable analyses. A logistic regression analyses was performed to calculate the OR (95% CI) for diagnosis of periodontitis in patients with SpA and matched controls. Results A diagnosis of periodontitis was established in 56% in patients with SpA versus 69% of healthy controls (P≤ 0.01). Severe periodontitis was found in 3% versus 12% in SpA versus healthy controls, respectively (P≤ 0.01). There was no significant increase of frequency of any periodontal variable, IgG1/IgG2 antibodies against P. gingivalis or the presence of periodontopathic bacteria between patients with SpA and control group. Periodontitis was not positively associated with a diagnosis of SpA (OR: 0.57, 95% CI 0.32 to 1.00, P=0.05) in the logistic regression analyses. Conclusions We found a lower rather than a higher frequency and severity of periodontitis in patients with SpA in comparison with healthy control individuals. Our findings suggest that there is no positive association between SpA and periodontitis in Colombian patients.
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Affiliation(s)
- Wilson Bautista-Molano
- Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia.,Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | | | - Robert Landewé
- Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, The Netherlands.,Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Gloria I Lafaurie
- Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Juliette de Ávila
- Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Rafael Valle-Oñate
- Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia
| | - Consuelo Romero-Sanchez
- Rheumatology Department, School of Medicine, Universidad Militar Nueva Granada and Hospital Militar, Bogota, Colombia.,Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
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35
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Jung H, Jung SM, Rim YA, Park N, Nam Y, Lee J, Park SH, Ju JH. Arthritic role of Porphyromonas gingivalis in collagen-induced arthritis mice. PLoS One 2017; 12:e0188698. [PMID: 29190705 PMCID: PMC5708830 DOI: 10.1371/journal.pone.0188698] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022] Open
Abstract
Epidemiological studies show an association between rheumatoid arthritis (RA) and periodontal disease. Porphyromonas gingivalis (P.gingivalis) is a well-known pathogen in periodontitis. This study investigated the pathogenic effects of P.gingivalis on autoimmune arthritis in vivo. Collagen-induced arthritis (CIA) mice were intraperitoneally injected with W83 and 2561 strains of P.gingivalis. Infection with P.gingivalis exacerbated arthritis score in CIA mice. Synovial inflammation and bone destruction in CIA mice infected with P.gingivalis were more severe than in uninfected CIA mice. Both W83 and 2561 strains were more pro-arthritic after arthritis symptom was fully activated. Interestingly, only W83 strain was arthritogenic before autoimmune reaction initiated. Citrullination was detected in synovial tissue of CIA mice and CIA mice inoculated with P.gingivalis, but not in normal control mice. The citrullinated area was greater in P.gingivalis-infected CIA mice than in non-infected CIA mice. This study showed that P.gingivalis exacerbated disease in a mouse model of autoimmune arthritis and increased the expression of citrullinated antigens in the synovium. The arthritogenic effects of P.gingivalis were at least in part, dependent upon the bacterial strain with or without fimbriae expression, route and time of infection. P.gingivalis-mediated citrullination may explain the possible link between periodontal disease and RA.
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Affiliation(s)
- Hyerin Jung
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Yeri Alice Rim
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Narae Park
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoojun Nam
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jennifer Lee
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyeon Ju
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Kim HJ, Cha GS, Joo JY, Lee J, Kim SJ, Lee J, Park SY, Choi J. Targeting the epitope spreader Pep19 by naïve human CD45RA + regulatory T cells dictates a distinct suppressive T cell fate in a novel form of immunotherapy. J Periodontal Implant Sci 2017; 47:292-311. [PMID: 29093987 PMCID: PMC5663667 DOI: 10.5051/jpis.2017.47.5.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose Beyond the limited scope of non-specific polyclonal regulatory T cell (Treg)-based immunotherapy, which depends largely on serendipity, the present study explored a target Treg subset appropriate for the delivery of a novel epitope spreader Pep19 antigen as part of a sophisticated form of immunotherapy with defined antigen specificity that induces immune tolerance. Methods Human polyclonal CD4+CD25+CD127lo− Tregs (127-Tregs) and naïve CD4+CD25+CD45RA+ Tregs (45RA-Tregs) were isolated and were stimulated with target peptide 19 (Pep19)-pulsed dendritic cells in a tolerogenic milieu followed by ex vivo expansion. Low-dose interleukin-2 (IL-2) and rapamycin were added to selectively exclude the outgrowth of contaminating effector T cells (Teffs). The following parameters were investigated in the expanded antigen-specific Tregs: the distinct expression of the immunosuppressive Treg marker Foxp3, epigenetic stability (demethylation in the Treg-specific demethylated region), the suppression of Teffs, expression of the homing receptors CD62L/CCR7, and CD95L-mediated apoptosis. The expanded Tregs were adoptively transferred into an NOD/scid/IL-2Rγ−/− mouse model of collagen-induced arthritis. Results Epitope-spreader Pep19 targeting by 45RA-Tregs led to an outstanding in vitro suppressive T cell fate characterized by robust ex vivo expansion, the salient expression of Foxp3, high epigenetic stability, enhanced T cell suppression, modest expression of CD62L/CCR7, and higher resistance to CD95L-mediated apoptosis. After adoptive transfer, the distinct fate of these T cells demonstrated a potent in vivo immunotherapeutic capability, as indicated by the complete elimination of footpad swelling, prolonged survival, minimal histopathological changes, and preferential localization of CD4+CD25+ Tregs at the articular joints in a mechanistic and orchestrated way. Conclusions We propose human naïve CD4+CD25+CD45RA+ Tregs and the epitope spreader Pep19 as cellular and molecular targets for a novel antigen-specific Treg-based vaccination against collagen-induced arthritis.
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Affiliation(s)
- Hyun-Joo Kim
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
| | - Gil Sun Cha
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
| | - Ji-Young Joo
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
| | - Juyoun Lee
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
| | - Sung-Jo Kim
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
| | - Jeongae Lee
- Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul, Korea
| | - So Youn Park
- Department of Pharmacology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jeomil Choi
- Department of Periodontology, Dental Research Institute, Pusan National University Dental Hospital, Pusan National University School of Dentistry, Yangsan, Korea
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Sun CL, Wei J, Bi LQ. Rutin Attenuates Oxidative Stress and Proinflammatory Cytokine Level in Adjuvant Induced Rheumatoid Arthritis via Inhibition of NF-κB. Pharmacology 2017; 100:40-49. [PMID: 28467992 DOI: 10.1159/000451027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Abstract
The present study was intended to elucidate the effect of rutin, a flavonoid, on arthritis in complete Freund's adjuvant-induced arthritic rats. The present study showed that more pronounced effect has been observed in the case of 15 mg/kg dose of rutin, with significant reduction in paw diameter together with positive modulation of hematological parameters as compared to 2 other tested doses. A significant upsurge in the level of superoxide dismutase, glutathione peroxidase and glutathione were observed together with decrease in the level of malondialdehyde after treatment with rutin in a dose-dependent manner. Furthermore, the effect of rutin on the tumor necrosis factor-α and interleukin-1β in arthritic rats showed does-dependent lowering of these cytokines with maximum benefit at 15 mg/kg dose and the level of both NF-κB p65 and NF-κBp65 (Ser536) has been significantly reduced in the presence of rutin. Histopathological examination showed that the inflammatory cells infiltration, synovial hyperplasia, pannus formation and cartilage and bone erosion had considerably improved on administration of rutin. In conclusion, our paper strongly demonstrated the protective effect of rutin against the rheumatoid arthritis involved via suppression of NF-κB p65 protein expression.
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Affiliation(s)
- Chong-Ling Sun
- Department of Rheumatology and Immunology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, and Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, Changchun, China
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Gittaboyina S, Koduganti RR, Aedula SD, Panthula VNR, Jammula SP, Dasari R, Gireddy H, Ambati M. Estimation of Pentraxin 3 and Porphyromonas Gingivalis Levels in Patients with Rheumatoid Arthritis and Periodontitis- An Observational Study. J Clin Diagn Res 2017; 11:ZC09-ZC12. [PMID: 28658898 PMCID: PMC5483800 DOI: 10.7860/jcdr/2017/24412.9792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Periodontal diseases are inflammatory in nature involving interplay between the bacterial plaque and the micro-organisms, with the response of the host playing a pivotal role in either attenuating or eliminating the disease. Rheumatoid Arthritis (RA) is also a chronic inflammatory disease which shares common risk factors with periodontitis. Porphyromonas Gingivalis and Pentraxin 3 (an acute inflammatory protein) have been observed to be associated with both the diseases. AIM This study was done to determine if there was any association between Pophyromonas Gingivalis and Pentraxin 3 levels in patients with RA and Chronic Periodontitis in comparison with Healthy controls. MATERIALS AND METHODS This observational study was conducted on 90 subjects (42 Males and 48 Females) aged between 30-60 years. The subjects were selected from the out patient ward of a tertiary referral care hospital. The selected subjects were equally divided into three groups. Group I: Comprising of 30 patients with RA and chronic periodontitis who were in turn, subdivided into Group I- A (n=15) -Patients just diagnosed with RA and Group I- B (n=15) Patients under medications for more than three months. Group II: Patients with Chronic Periodontitis (n=30) and Group III: Healthy Controls (n=30) Intergroup comparison for continuous data was done by One-way analysis of variance test followed by Bonferroni's post-hoc test. Intragroup comparison for continuous data was done by paired t-test. RESULTS Intergroup comparison between Group I and Group II did not show any statistical difference pertaining to the clinical parameters except for the Gingival Index (GI) which was found to be higher in Group II (Mean= 2.07) when compared to Group I (Mean=1.59). Intragroup comparison between Group IA and Group IB was statistically significant for GI, Plaque Index (PI), and Clinical Attachment Levels (CAL). Intragroup comparison between Group I-A and Group I-B showed that both Porphyromonas gingivalis and Pentraxin 3 Levels were higher in Group I- A. CONCLUSION In this study, it was observed that there was a positive association between Porphyromonas gingivalis and Pentraxin 3 levels in patients with rheumatoid arthritis and periodontitis.
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Affiliation(s)
- Shankar Gittaboyina
- Postgraduate Student, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Rekha Rani Koduganti
- Professor and Head, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Srisaila Datta Aedula
- Professor and Head, Department of Rheumatology, KIMS, Secunderabad, Hyderabad, Telangana, India
| | - Veerendra Nath Reddy Panthula
- Professor, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Surya Prasanna Jammula
- Professor, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Rajashree Dasari
- Reader, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Himabindu Gireddy
- Reader, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Manasa Ambati
- Senior Lecturer, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
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Persson GR. Dental geriatrics and periodontitis. Periodontol 2000 2017; 74:102-115. [DOI: 10.1111/prd.12192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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Kirchner A, Jäger J, Krohn-Grimberghe B, Patschan S, Kottmann T, Schmalz G, Mausberg RF, Haak R, Ziebolz D. Active matrix metalloproteinase-8 and periodontal bacteria depending on periodontal status in patients with rheumatoid arthritis. J Periodontal Res 2017; 52:745-754. [DOI: 10.1111/jre.12443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 12/30/2022]
Affiliation(s)
- A. Kirchner
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - J. Jäger
- Department of Preventive Dentistry, Periodontology and Cariology; University Medical Centre Goettingen; Goettingen Germany
| | | | - S. Patschan
- Department of Nephrology and Rheumatology; University Medical Centre Goettingen; Goettingen Germany
| | - T. Kottmann
- Clinical Research Organisation; Hamm Germany
| | - G. Schmalz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - R. F. Mausberg
- Department of Preventive Dentistry, Periodontology and Cariology; University Medical Centre Goettingen; Goettingen Germany
| | - R. Haak
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - D. Ziebolz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
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Mühlberg S, Jäger J, Krohn-Grimberghe B, Patschan S, Mausberg RF, Schmalz G, Haak R, Ziebolz D. Oral health-related quality of life depending on oral health in patients with rheumatoid arthritis. Clin Oral Investig 2017; 21:2661-2670. [DOI: 10.1007/s00784-017-2068-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
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42
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Äyräväinen L, Leirisalo-Repo M, Kuuliala A, Ahola K, Koivuniemi R, Meurman JH, Heikkinen AM. Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population. BMJ Open 2017; 7:e011916. [PMID: 28143836 PMCID: PMC5293865 DOI: 10.1136/bmjopen-2016-011916] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health. DESIGN Prospective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16 months later. Controls were examined once. SETTINGS AND PARTICIPANTS The study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) naїve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants. OUTCOME MEASURES Degree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria. RESULTS Moderate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth ≥4 mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results. CONCLUSIONS Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.
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Affiliation(s)
- Leena Äyräväinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Marjatta Leirisalo-Repo
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Kuuliala
- Department of Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Ahola
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Riitta Koivuniemi
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Anna Maria Heikkinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
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Eriksson K, Lönnblom E, Tour G, Kats A, Mydel P, Georgsson P, Hultgren C, Kharlamova N, Norin U, Jönsson J, Lundmark A, Hellvard A, Lundberg K, Jansson L, Holmdahl R, Yucel-Lindberg T. Effects by periodontitis on pristane-induced arthritis in rats. J Transl Med 2016; 14:311. [PMID: 27809921 PMCID: PMC5094068 DOI: 10.1186/s12967-016-1067-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/20/2016] [Indexed: 12/29/2022] Open
Abstract
Background An infection-immune association of periodontal disease with rheumatoid arthritis has been suggested. This study aimed to investigate the effect of pre-existing periodontitis on the development and the immune/inflammatory response of pristane-induced arthritis. Methods We investigated the effect of periodontitis induced by ligature placement and Porphyromonas gingivalis (P. gingivalis) infection, in combination with Fusobacterium nucleatum to promote its colonization, on the development of pristane-induced arthritis (PIA) in rats (Dark Agouti). Disease progression and severity of periodontitis and arthritis was monitored using clinical assessment, micro-computed tomography (micro-CT)/intraoral radiographs, antibody response, the inflammatory markers such as α-1-acid glycoprotein (α-1-AGP) and c-reactive protein (CRP) as well as cytokine multiplex profiling at different time intervals after induction. Results Experimentally induced periodontitis manifested clinically (P < 0.05) prior to pristane injection and progressed steadily until the end of experiments (15 weeks), as compared to the non-ligated arthritis group. Injection of pristane 8 weeks after periodontitis-induction led to severe arthritis in all rats demonstrating that the severity of arthritis was not affected by the pre-existence of periodontitis. Endpoint analysis showed that 89% of the periodontitis-affected animals were positive for antibodies against arginine gingipain B and furthermore, the plasma antibody levels to a citrullinated P. gingivalis peptidylarginine deiminase (PPAD) peptide (denoted CPP3) were significantly (P < 0.05) higher in periodontitis rats with PIA. Additionally, there was a trend towards increased pro-inflammatory and anti-inflammatory cytokine levels, and increased α-1-AGP levels in plasma from periodontitis-challenged PIA rats. Conclusions Pre-existence of periodontitis induced antibodies against citrullinated peptide derived from PPAD in rats with PIA. However, there were no differences in the development or severity of PIA between periodontitis challenged and periodontitis free rats. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1067-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaja Eriksson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden.
| | - Erik Lönnblom
- Section for Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gregory Tour
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden.,Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Alfred Nobels Allé 8, 141 83, Huddinge, Sweden
| | - Anna Kats
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden
| | - Piotr Mydel
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, The Laboratory Building, 5th Floor, 5021, Bergen, Norway
| | - Pierre Georgsson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden
| | - Catharina Hultgren
- Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital, Alfred Nobels Allé 8, 141 83, Huddinge, Sweden
| | - Nastya Kharlamova
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Rheumatology Clinic D2:01, 171 76, Stockholm, Sweden
| | - Ulrika Norin
- Section for Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Jörgen Jönsson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden
| | - Anna Lundmark
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden
| | - Annelie Hellvard
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, The Laboratory Building, 5th Floor, 5021, Bergen, Norway.,Malopolska Centre of Biotechnology, Jagiellonian University, Gronostajowa 7a, 30-387, Kraków, Poland
| | - Karin Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Rheumatology Clinic D2:01, 171 76, Stockholm, Sweden
| | - Leif Jansson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden.,Department of Periodontology at Eastmaninstitutet, Stockholm County Council, Dalagatan 11, 113 24, Stockholm, Sweden
| | - Rikard Holmdahl
- Section for Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Center for Medical Immunopharmacology Research, Southern Medical University, Guangzhou, China
| | - Tülay Yucel-Lindberg
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04, Huddinge, Sweden.
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Chang HH, Liu GY, Dwivedi N, Sun B, Okamoto Y, Kinslow JD, Deane KD, Demoruelle MK, Norris JM, Thompson PR, Sparks JA, Rao DA, Karlson EW, Hung HC, Holers VM, Ho IC. A molecular signature of preclinical rheumatoid arthritis triggered by dysregulated PTPN22. JCI Insight 2016; 1:e90045. [PMID: 27777982 DOI: 10.1172/jci.insight.90045] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A unique feature of rheumatoid arthritis (RA) is the presence of anti-citrullinated protein antibodies (ACPA). Several risk factors for RA are known to increase the expression or activity of peptidyl arginine deiminases (PADs), which catalyze citrullination and, when dysregulated, can result in hypercitrullination. However, the consequence of hypercitrullination is unknown and the function of each PAD has yet to be defined. Th cells of RA patients are hypoglycolytic and hyperproliferative due to impaired expression of PFKFB3 and ATM, respectively. Here, we report that these features are also observed in peripheral blood mononuclear cells (PBMCs) from healthy at-risk individuals (ARIs). PBMCs of ARIs are also hypercitrullinated and produce more IL-2 and Th17 cytokines but fewer Th2 cytokines. These abnormal features are due to impaired induction of PTPN22, a phosphatase that also suppresses citrullination independently of its phosphatase activity. Attenuated phosphatase activity of PTPN22 results in aberrant expression of IL-2, ATM, and PFKFB3, whereas diminished nonphosphatase activity of PTPN22 leads to hypercitrullination mediated by PADs. PAD2- or PAD4-mediated hypercitrullination reduces the expression of Th2 cytokines. By contrast, only PAD2-mediated hypercitrullination can increase the expression of Th17 cytokines. Taken together, our data depict a molecular signature of preclinical RA that is triggered by impaired induction of PTPN22.
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Affiliation(s)
- Hui-Hsin Chang
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Guang-Yaw Liu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Nishant Dwivedi
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Sun
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Yuko Okamoto
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer D Kinslow
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Paul R Thompson
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak A Rao
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hui-Chih Hung
- Department of Life Sciences and.,Agricultural Biotechnology Center and Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
| | - V Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - I-Cheng Ho
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Kaur G, Balamurugan P, Uma Maheswari C, Anitha A, Princy SA. Combinatorial Effects of Aromatic 1,3-Disubstituted Ureas and Fluoride on In vitro Inhibition of Streptococcus mutans Biofilm Formation. Front Microbiol 2016; 7:861. [PMID: 27375583 PMCID: PMC4893485 DOI: 10.3389/fmicb.2016.00861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/23/2016] [Indexed: 01/11/2023] Open
Abstract
Dental caries occur as a result of disequilibrium between acid producing pathogenic bacteria and alkali generating commensal bacteria within a dental biofilm (dental plaque). Streptococcus mutans has been reported as a primary cariogenic pathogen associated with dental caries. Emergence of multidrug resistant as well as fluoride resistant strains of S. mutans due to over use of various antibiotics are a rising problem and prompted the researchers worldwide to search for alternative therapies. In this perspective, the present study was aimed to screen selective inhibitors against ComA, a bacteriocin associated ABC transporter, involved in the quorum sensing of S. mutans. In light of our present in silico findings, 1,3-disubstituted urea derivatives which had better affinity to ComA were chemically synthesized in the present study for in vitro evaluation of S. mutans biofilm inhibition. The results revealed that 1,3-disubstituted urea derivatives showed good biofilm inhibition. In addition, synthesized compounds exhibited potent synergy with a very low concentration of fluoride (31.25-62.5 ppm) in inhibiting the biofilm formation of S. mutans without affecting the bacterial growth. Further, the results were supported by confocal laser scanning microscopy. On the whole, from our experimental results we conclude that the combinatorial application of fluoride and disubstituted ureas has a potential synergistic effect which has a promising approach in combating multidrug resistant and fluoride resistant S. mutans in dental caries management.
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Affiliation(s)
- Gurmeet Kaur
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - P. Balamurugan
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - C. Uma Maheswari
- Organic Synthesis Group, Department of Chemistry, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - A. Anitha
- Organic Synthesis Group, Department of Chemistry, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - S. Adline Princy
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
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Eriksson K, Nise L, Kats A, Luttropp E, Catrina AI, Askling J, Jansson L, Alfredsson L, Klareskog L, Lundberg K, Yucel-Lindberg T. Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis: A Swedish Population Based Case-Control Study. PLoS One 2016; 11:e0155956. [PMID: 27203435 PMCID: PMC4874595 DOI: 10.1371/journal.pone.0155956] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/06/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The possible hypothesis of a link between periodontitis and rheumatoid arthritis (RA), specifically anti-citrullinated protein antibody (ACPA) positive RA, prompted us to investigate the prevalence of periodontitis in the Swedish Epidemiological Investigation of RA (EIRA), a well-characterised population-based RA case-control cohort. METHODS Periodontal status of 2,740 RA cases and 3,942 matched controls was retrieved through linking EIRA with the National Dental Health Registry (DHR), where dental diagnostic- and treatment codes on the adult Swedish population have been registered. Dental records from 100 cases and controls were reviewed to validate the periodontal diagnostic codes in DHR. RESULTS The reviewed dental records confirmed 90% of the periodontitis diagnoses in DHR among RA cases, and 88% among controls. We found the positive predictive value of periodontitis diagnoses in the DHR to be 89% (95% CI 78 to 95%) with a sensitivity of 77% (95% CI: 65 to 86%). In total, 86% of EIRA participants were identified in DHR. The risk for periodontitis increased by age and current smoking status in both cases as well as controls. No significant differences in prevalence of periodontal disease in terms of gingivitis, periodontitis, peri-implantitis or increased risk for periodontitis or peri-implantitis were observed between RA cases and controls. In addition, there was no difference on the basis of seropositivity, ACPA or rheumatoid factor (RF), among patients with RA. CONCLUSIONS Our data verify that smoking and ageing are risk factors for periodontitis, both in RA and controls. We found no evidence of an increased prevalence of periodontitis in patients with established RA compared to healthy controls, and no differences based on ACPA or RF status among RA subjects.
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Affiliation(s)
- Kaja Eriksson
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Lena Nise
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Anna Kats
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Elin Luttropp
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Anca Irinel Catrina
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Leif Jansson
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
- Department of Periodontology at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
- Centre of Environmental and Occupational Medicine, Stockholm County Council, Stockholm, Sweden
| | - Lars Klareskog
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Karin Lundberg
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Tülay Yucel-Lindberg
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
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Andreev-Andrievskiy AA, Kolosova NG, Stefanova NA, Lovat MV, Egorov MV, Manskikh VN, Zinovkin RA, Galkin II, Prikhodko AS, Skulachev MV, Lukashev AN. Efficacy of Mitochondrial Antioxidant Plastoquinonyl-decyl-triphenylphosphonium Bromide (SkQ1) in the Rat Model of Autoimmune Arthritis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:8703645. [PMID: 27293517 PMCID: PMC4887630 DOI: 10.1155/2016/8703645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/22/2016] [Accepted: 04/18/2016] [Indexed: 12/30/2022]
Abstract
Rheumatoid arthritis is one of the most common autoimmune diseases. Many antioxidants have been tested in arthritis, but their efficacy was, at best, marginal. In this study, a novel mitochondria-targeted antioxidant, plastoquinonyl-decyl-triphenylphosphonium bromide (SkQ1), was tested in vivo to prevent and cure experimental autoimmune arthritis. In conventional Wistar rats, SkQ1 completely prevented the development of clinical signs of arthritis if administered with food before induction. Further, SkQ1 significantly reduced the fraction of animals that developed clinical signs of arthritis and severity of pathological lesions if administration began immediately after induction of arthritis or at the onset of first symptoms (day 14 after induction). In specific pathogen-free Wistar rats, SkQ1 administered via gavage after induction of arthritis did not reduce the fraction of animals with arthritis but decreased the severity of lesions upon pathology examination in a dose-dependent manner. Efficacious doses of SkQ1 were in the range of 0.25-1.25 nmol/kg/day (0.13-0.7 μg/kg/day), which is much lower than doses commonly used for conventional antioxidants. SkQ1 promoted apoptosis of neutrophils in vitro, which may be one of the mechanisms underlying its pharmacological activity. Considering its low toxicity and the wide therapeutic window, SkQ1 may be a valuable additional therapy for rheumatoid arthritis.
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Affiliation(s)
- Alexander A. Andreev-Andrievskiy
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
- Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Maxim V. Lovat
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
| | - Maxim V. Egorov
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
| | - Vasily N. Manskikh
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
| | - Roman A. Zinovkin
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
- Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Ivan I. Galkin
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | - Maxim V. Skulachev
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander N. Lukashev
- Institute of Mitoengineering, Lomonosov Moscow State University, Moscow, Russia
- Martsinovsky Institute of Medical Parasitology and Tropical Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
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Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to Mouth: A Systematic Review and Meta-Analysis of the Association between Rheumatoid Arthritis and Periodontitis. Front Immunol 2016; 7:80. [PMID: 26973655 PMCID: PMC4774606 DOI: 10.3389/fimmu.2016.00080] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/18/2016] [Indexed: 12/29/2022] Open
Abstract
Background Rheumatoid arthritis (RA) and periodontitis are both chronic inflammatory diseases, which demonstrate similarities in terms of mechanism, histopathology, and demography. An association between these conditions has been demonstrated previously but has been called into question more recently. Methods The published databases, such as MEDLINE, EMBASE, and PsycINFO, were searched using search terms related to RA and periodontitis. Articles were selected if they included data on the number of people with RA diagnosed with periodontitis (or periodontal disease parameters) compared to a control comparison group. Review articles, case reports, animal model studies, non-English language, and articles with unavailable abstracts were excluded. Data were extracted, critically appraised using the Downs and Black tool, and a random-effect Mantel–Haenszel meta-analysis was performed. Results Twenty-one papers met the eligibility criteria and provided data for the meta-analysis; 17 studies (including a total of 153,492 participants) comparing RA to healthy controls and 4 (including a total of 1378 participants) comparing RA to osteoarthritis (OA). There was a significantly increased risk of periodontitis in people with RA compared to healthy controls (relative risk: 1.13; 95% CI: 1.04, 1.23; p = 0.006; N = 153,277) with a significantly raised mean probing depth, risk of bleeding on probing (BOP), and absolute value of clinical attachment loss in those with RA. When comparing RA and OA, there was no significant difference in the prevalence of periodontitis; however, the risk of BOP was greater in OA than RA. Conclusion A significant association between RA and periodontitis is supported by the results of our systematic review and meta-analysis of studies comparing RA to healthy controls. In our meta-analysis, however, this is not replicated when comparing RA to OA controls.
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Affiliation(s)
- Nicholas R Fuggle
- Musculoskeletal Research Group, Institute of Infection and Immunity, St George's University of London , London , UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia , Norwich , UK
| | - Arvind Kaul
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust , London , UK
| | - Nidhi Sofat
- Musculoskeletal Research Group, Institute of Infection and Immunity, St George's University of London, London, UK; Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
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Grasso MA, Comer AC, DiRenzo DD, Yesha Y, Rishe ND. Using Big Data to Evaluate the Association between Periodontal Disease and Rheumatoid Arthritis. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:589-593. [PMID: 26958193 PMCID: PMC4765642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An association between periodontal disease and rheumatoid arthritis is believed to exist. Most investigations into a possible relationship have been case-control studies with relatively low sample sizes. The advent of very large clinical repositories has created new opportunities for data-driven research. We conducted a retrospective cohort study to measure the association between periodontal disease and rheumatoid arthritis in a population of 25 million patients. We demonstrated that subjects with periodontal disease were roughly 1.4 times more likely to have rheumatoid arthritis. These results compare favorably with those of previous studies on smaller cohorts. Additional work is needed to identify the mechanisms behind this association and to determine if aggressive treatment of periodontal disease can alter the course of rheumatoid arthritis.
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Affiliation(s)
| | - Angela C Comer
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dana D DiRenzo
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Yelena Yesha
- University of Maryland Baltimore County, Baltimore, Maryland
| | - Naphtali D Rishe
- Florida International University and NOA Data Science Institute Inc, Miami, Florida
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Chou YY, Lai KL, Chen DY, Lin CH, Chen HH. Rheumatoid Arthritis Risk Associated with Periodontitis Exposure: A Nationwide, Population-Based Cohort Study. PLoS One 2015; 10:e0139693. [PMID: 26426533 PMCID: PMC4591281 DOI: 10.1371/journal.pone.0139693] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The risk of periodontitis (PD) is increased in the patient group of rheumatoid arthritis (RA). RA and PD also shared some pathological mechanism. The aim of this study is to investigate the risk of RA associated with PD exposure. METHODS AND FINDINGS This study identified 3 mutually exclusive cohorts using the 1999-2010 Taiwanese National Health Insurance Research Database (NHIRD) to investigate the association between PD and the risk of incident RA. All patients with PD in 2000 were identified from the database of all enrollees as the PD cohort. From the representative database of 1,000,000 enrollees randomly selected in 2010 (LHID2010), individuals without any periodontal disease (PO) during 1999-2010 were selected as the non-PO cohort. Individuals who were not included in the non-PO cohort and received dental scaling (DS) no more than two times per year during 1999-2010 were selected as the DS cohort from LHID2010. Using cox proportional regression analysis, hazard ratios (HRs) with 95% confidence intervals (Cis) were calculated to quantify the association between PD exposure and RA development. In the three-group comparison using the non-PO cohort as reference, we found that the risk of RA was higher in the PD and DS cohorts (HRs, 1.89 and 1.43; 95% CIs, 1.56-2.29 and 1.09-1.87, respectively). For comparisons between two cohorts, the PD cohort had a higher risk of RA than the non-PO and DS cohorts (HRs, 1.91 and 1.35; 95% CIs, 1.57-2.30 and 1.09-1.67, respectively). CONCLUSION PD was associated with an increased risk of RA development.
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Affiliation(s)
- Yin-Yi Chou
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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