Abstract
Objective: Rheumatoid arthritis and periodontal disease are associated together, but the effect of therapy provided for one disease to the second one remained under-investigated. This study investigated effect of infliximab therapy used to treat rheumatoid arthritis (RA) on various biomarkers of periodontal disease (PD) severity including serologies of Porphyromonas gingivalis and Prevotella intermedia and matrix metalloproteinase 3. Methods: Seventy nine RA patients were enrolled at the time to start infliximab therapy and the 28 joint disease activity score (DAS28), anti-cyclic citrullinated petides 2nd generation (anti-CCP2), anti-P. gingivalis antibody, and Matrix metalloproteinase 3 (MMP-3) were monitored before and at 6 months of infliximab therapy. Joint damage and severe periodontal disease were assessed at baseline. Anti-CCP2, anti-P. gingivalis antibody, and MMP-3 were determined by enzyme-linked immunosorbent assay (ELISA). Results: At baseline, anti-CCP2 titers were associated with anti-P. gingivalis lipopolysaccharide (LPS)-specific antibodies titers (p < 0.05). Anti-P. gingivalis antibodies were not significantly correlated with clinical, biological, or destruction parameters of RA disease. At 6 months of infliximab therapy, MMP-3 level decreased (from 119 ± 103 ng/mL to 62.44 ± 52 ng/mL; p < 0.0001), whereas P. gingivalis antibody levels remained at the same level. DAS28 and inflammation markers C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) also decreased significantly during infliximab therapy (p < 0.05) as anti-CCP2 levels (p < 0.001). Only high MMP-3 level at baseline was associated with infliximab efficacy (p < 0.01). Conclusion: MMP-3 level can be a useful marker of the efficacy of infliximab in RA patients. The treatment did not affect anti-P. gingivalis antibodies.
Highlights
Rheumatoid arthritis (RA) is the most frequently chronic inflammatory joint disease characterized by synovial hypertrophy and inflammation with joint and subchondral bone destruction, which correlates with disability and loss of function [1]
Our rheumatoid arthritis (RA) population had the main characteristics of RA patients treated with tumor necrosis factor alpha (TNF) inhibitors as reported in the Table 1
Severe periodontal disease (PD) was present in 51 RA patients and severe PD was associated with joint damage (χ2 test = 4.4; p = 0.0276)
Summary
Rheumatoid arthritis (RA) is the most frequently chronic inflammatory joint disease characterized by synovial hypertrophy and inflammation with joint and subchondral bone destruction, which correlates with disability and loss of function [1]. Strategy based on MMP-3 monitoring improved clinical response and reduced joint destruction in RA [20] In both PD and, R.A., production of proinflammatory cytokines, as TNF., is increased and specific blocking of TNF improves two-third of RA patients [21]. Few studies explored therapeutic effect for PD on RA [24] and vice versa [25] Since both diseases are associated at the susceptibility and severity level [24], therapy from one disease should be efficient to the second one. Our aim in this study was to correlate marker of PD severity (MMP-3, anti-P. gingivalis and anti-P. intermedia antibodies) and to assess effect of infliximab therapy on PD severe biomarkers in RA patients. The usefulness of these biomarkers was assessed for prediction of clinical response to infliximab therapy
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