Antibodies against citrullinated proteins in relation to periodontitis with or without rheumatoid arthritis: a cross-sectional study

Pit Hui Lew,Rathna Devi Vaithilingam,Mohammad Tariqur Rahman,Nor Adinar Baharuddin,Peter Mark Bartold,Syarida Hasnur Safii,Sargunan Sockalingam,Noor Lide Abu Kassim

doi:10.1186/s12903-021-01712-y

Abstract

BackgroundPrevious studies have reported conflicting findings between serum anti-citrullinated protein antibodies (ACPA) levels in rheumatoid arthritis (RA) participants with and without periodontitis (Pd). This study aimed to analyse possible correlations between serum ACPA levels and clinical parameters in Pd and RA participants.MethodsFull mouth periodontal examination (probing pocket depth, clinical attachment levels, gingival bleeding index, visual plaque index) was conducted and serum samples obtained from 80 participants comprising RA, Pd, both RA and Pd (RAPd) and healthy individuals (HC). Erythrocyte sedimentation rates (ESR) and periodontal inflamed surface area (PISA) were obtained. Serum samples were analysed for ACPA quantification using enzyme-linked immunosorbent assay (ELISA).ResultsMedian levels (IU/mL) of ACPA (interquartile range, IQR) in RAPd, RA, Pd and HC groups were 118.58(274.51), 102.02(252.89), 78.48(132.6) and 51.67(91.31) respectively. ACPA levels were significantly higher in RAPd and RA as compared to HC group (p < 0.05). However, ACPA levels of any of the groups were not correlated with any clinical periodontal and RA parameters within the respective groups.ConclusionsAt individual level, the amount of serum ACPA seem to have an increasing trend with the diseased condition in the order of RAPd > RA > Pd > HC. However, lack of any significant correlation between the serum ACPA levels with the clinical Pd and RA parameters warrants further studies to investigate the causal link between RA and Pd for such a trend. Further studies involving more inflammatory biomarkers might be useful to establish the causal link between Pd in the development and progression of RA or vice versa.

Highlights

Previous studies have reported conflicting findings between serum anti-citrullinated protein antibodies (ACPA) levels in rheumatoid arthritis (RA) participants with and without periodontitis (Pd)
Characteristics of participants Participants from the Pd and Subjects without RA and Pd/healthy individuals (HC) groups were generally younger than RA group
Most participants in all four groups were females while those in the RA and Pd (RAPd) and Pd groups were diagnosed with localised moderate to severe Pd

Summary

Introduction

Previous studies have reported conflicting findings between serum anti-citrullinated protein antibodies (ACPA) levels in rheumatoid arthritis (RA) participants with and without periodontitis (Pd). Despite the differences in their initiating aetiological mechanisms, both chronic inflammatory conditions share a similar host mediated pathogenesis characterised by similar sets of pro-inflammatory cytokines, and risk factors (such as smoking, obesity and ageing), that justify a plausible link between them [6] which subsequently impacts their oral health related quality of life [7, 8]. Pathogenic T and B cells are activated, leading to the formation of RA-specific anti-citrullinated protein antibodies (ACPA) [10]. Detection of these antibodies in the serum of participants with RA has been well documented [11, 12]. The presence of these same autoantibodies in the serum of participants with periodontitis has been reported in several studies [13,14,15]

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