Oral health and plaque microbial profile in juvenile idiopathic arthritis

Sriharsha Grevich,Sarah Ringold,Kyle Hager,Joseph Kelly,Peggy Lee,Richard Darveau,Amy Kim,Hillary Hayden,Elizabeth Velan,Samuel Miller,Anne Stevens,Hannah Leahey,Joel Berg,Camille Baltuck,Jeffrey Mclean,Gretchen Henstorf,Mitchell Brittnacher,Brian Leroux,Anne Reeves

doi:10.1186/s12969-019-0387-5

Abstract

BackgroundThe oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA).MethodsA cross-sectional exploratory study of subjects aged 10–18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing.ResultsThe study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented.ConclusionIncreased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Highlights

The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity
Oral health Periodontitis is exceedingly rare in immunocompetent children, and we did not detect significant periodontal disease in any subject
We found that the juvenile idiopathic arthritis (JIA) patients did not have overall worse oral hygiene, but rather better gingival indices compared to the dental group (p = 0.002) and non-significant trends toward better plaque and Decay missing filling teeth (DMFT) indices

Summary

Introduction

The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). Juvenile idiopathic arthritis (JIA) is a common rheumatologic disorder that can lead to significant disability. A current hypothesis is that environmental triggers interact with specific human leukocyte antigen (HLA) and innate immunity genes associated with JIA [1]. Gene expression in JIA reflects innate and adaptive immune activation similar to that reported in periodontitis [12, 13]. But not all studies reporting higher rates of gingivitis and dental decay in children with JIA could not rule out the possibility that poor dental hygiene was due to disability from arthralgias in fingers or temporomandibular joints (TMJs) [16,17,18,19]. Evidence for P. gingivalis has been found in multiple subtypes of JIA [20]

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Discussion

Conclusion