Association between periodontitis and anti-citrullinated protein antibodies in rheumatoid arthritis patients: a cross-sectional study

Jerián González-Febles,Federico Díaz-González,Jorge Garnier-Rodríguez,Enrique González-Dávila,Martina Hernández-González,Mariano Sanz,Sagrario Bustabad,Carlos Sánchez-Piedra,Beatriz Rodríguez-Lozano

doi:10.1186/s13075-020-2121-6

Abstract

AimThe aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients.Materials and methodsThis cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR).ResultsA significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p < 0.001), and 1.031 (p = 0.031), respectively. Furthermore, a significant increase of 4.45 U/mL in anti-CCP antibodies levels (p = 0.002) in RA patients was found for each pocket ≥ 5 mm after adjusting for age, gender, smoking, time of disease evolution, and RA activity.ConclusionsIn RA patients, the severity of periodontal conditions such as mean CAL, mean PI, and the number of pockets ≥ 5 mm were linearly associated with both the presence and levels of anti-CCP antibodies.

Highlights

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by painful joint inflammation, disability, and increased mortality [1]
Presence of anti-CCP antibodies was not associated with age, gender, race, C-reactive protein (CRP), BMD, smoking, dyslipidemia, hypertension, body mass index (BMI), or myocardial infarction, while a significant association was demonstrated with higher stress levels, erythrocyte sedimentation rate (ESR), and overweight
When patients were categorized by disease activity, no significant differences were observed between anti-CCP antibodies positive and negative patients

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by painful joint inflammation, disability, and increased mortality [1]. A complex interplay of genetic, environmental, and hormonal factors seem to influence the host immune tolerance leading to the characteristic autoimmune response of RA mainly characterized by the presence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs). These factors may affect the mucosal surfaces of lungs, gut, and/or the periodontium [2, 3]. In patients with chronic periodontitis, high levels of citrullinated proteins have been identified within the periodontal tissues [12] and a recent in vivo experimental study has demonstrated a positive correlation between P. gingivalis-induced periodontitis and anti-cyclic citrullinated peptide (anti-CCP) antibodies levels in rats [13]. Recently published evidence suggests that the presence of P. gingivalis infections may precede the clinical onset of RA years in advance [14]

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