Rheumatoid arthritis (RA) patients have a greater prevalence and severity of periodontitis than the non-arthritis population, according to a new study published in theKorean Journal of Internal Medicine. This association between RA and periodontitis implies that certain features of the inflammatory response could be common to both diseases.
The researchers enrolled a total of 352 periodontitis patients, 264 with RA and 88 age- and sex-matched controls who did not have arthritis. Periodontitis is characterized by loss of the periodontal ligament and alveolar bone and is a major cause of tooth loss. Results showed that prevalence of moderate to severe periodontitis was significantly higher in RA patients compared to controls (63.6% vs. 34.1%; P<0.001).
Results also displayed how antibodies against the citrullinated protein are more abundant in patients with severe periodontal inflammation. In markers of periodontal inflammation, bleeding on probing was correlated with disease activity score 28 (R=0.128, P=0.041), RA disease duration (R=0.211, P=0.001), erythrocyte sedimentation rate (ESR; R=0.141, P=0.023), anti-cyclic citrullinated peptide antibody (R=0.183, P=0.009), and anti-citrullinated α-enolase peptide-1 antibody (R=0.143, P=0.025).
The authors suspect that, similar to the lungs of smokers, chronic exposure to citrullinated proteins in patients with periodontitis may also predispose susceptible individuals to the development of autoantibodies and the initiation of RA. Conversely, the presence of RA may also predispose patients to periodontitis. Several mechanisms were expected to result in increased periodontitis in the patients with RA, including the presence of sicca syndrome, the use of medications like corticosteroids or immunosuppressant, and the loss of manual dexterity required for oral hygiene practices.
The authors conclude that periodontitis may provide a novel source of citrullinated proteins which could produce an anti-citrullinated antibody response in RA. They point to a recent study which investigated titers of anti-CCP antibody, anti-CEP-1 antibody, anti-citrullinated vimentin, and anti-citrullinated fibrinogen in non-RA individuals, which found that those with periodontitis displayed a significantly higher antibody response than those without periodontitis.
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