Abstract
ObjectiveThe possibility of infectious trigger at the gingival site in rheumatoid arthritis (RA) was reported in previous studies. The aim of our study is to determine the organisms causing periodontitis (PD) in a cohort of Egyptian patients with RA and their relation to serum and gingival anticitrullinated peptide protein antibodies (ACPA) level and other disease parameters.Patients and methodsA prospective cohort study was conducted on 100 consecutive Egyptian patients with RA. Disease activity was assessed by applying disease activity score-28, and functional status was measured using health assessment questionnaire. Dental examination, serum rheumatoid factor, ACPA in serum and gingival crevicular fluid (GCF), and radiograph of the hands were done for all patients. GCF culture was performed for all cases with PD for Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), and Prevotella intermedia (Pi).ResultsOf the 100 patients, 66 patients had PD; of them, GCF culture was performed, and Pg, Aa, and Pi were found in 60.6, 15.2, and 30.3% of patients with RA with PD, respectively. Gingival ACPA showed significant higher level with Pg than Pi cases (P=0.047). No statistically significant difference was detected on comparing Pg with Aa or Aa with Pi. Aa-positive cases were associated with significantly higher level of C-reactive protein than Pi-positive cases (P=0.029), whereas no statistical significant difference was detected between Pg- and Aa-positive or Pi-positive cases.ConclusionOur findings support the relationship between PD and infectious trigger at the gingival site and RA. Pg is the most prevalent periodontal microbiota in our cohort of patients with RA with PD that is associated with significant higher level of gingival ACPA. None of the detected organisms correlated with the degree of RA activity or other disease parameters, apart from significantly higher C-reactive protein level with Aa.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that is characterized by synovial inflammation and erosive arthritis [1]
Immunological profile included rheumatoid factor (RF) titer (Rose Waaler test) [20], serum, and gingival crevicular fluid (GCF) anticitrullinated peptide protein antibodies (ACPA) [21]. For those with proven PD, GCF culture was performed for Porphyromonas gingivalis (Pg), Aa, and Prevotella intermedia (Pi)
The mean DAS was 5.76±1.47, with 3% of patients were in remission, 3% had low disease activity, 31% had moderate disease activity, and 63% had high disease activity
Summary
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that is characterized by synovial inflammation and erosive arthritis [1]. An infectious cause of RA has been implicated; solid evidences are lacking. Microbiome is a term that describes certain bacterial colonies that populate skin and mucosal surfaces [2]. Several data demonstrated the role of microbiome in the pathogenesis of RA. Mucosal sites exposed to bacterial antigens, such as the gingiva and gut, may represent the initial site of immune autoreactivation [3]. Periodontitis (PD) is a chronic inflammatory gingival disease that serves as a reservoir for many organisms and inflammatory mediators [4]. A large surface area of the ulcerated pocket epithelium allows exchange between bacterial and host products
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