Dental News - Periodontal disease may be key initiator of rheumatoid arthritis

Dental Tribune International

Mon. 2. July 2018

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AMSTERDAM, Netherlands: In recent years, increasing attention has been given to aspects of oral health in patients with rheumatoid arthritis (RA), especially related to associations with periodontal disease. The results of a study conducted at the University of Leeds in the UK, and recently presented at the Annual European Congress of Rheumatology (EULAR 2018) in Amsterdam, demonstrated increased levels of periodontal disease and disease-causing bacteria in individuals at risk of RA.

The study found that the prevalence of periodontal disease was increased in patients with RA and could be a key initiator of RA-related autoimmunity. This is because autoimmunity in RA is characterised by an antibody response to citrullinated proteins in which the amino acid arginine has been converted into the amino acid citrulline, altering the proteins’ structure. The oral bacterium Porphyromonas gingivalis is the only human pathogen known to express an enzyme that can generate citrullinated proteins.

The study included 48 at-risk individuals (positive test for anti-citrullinated protein antibodies), 26 patients with RA and 32 healthy controls. The three groups were balanced regarding age, sex and smoking.

“It has been shown that RA-associated antibodies, such as anti-citrullinated protein antibodies, are present well before any evidence of joint disease. This suggests they originate from a site outside of the joints,” said study author Dr Kulveer Mankia, clinical research fellow at the university’s Institute of Rheumatic and Musculoskeletal Medicine. “Our study is the first to describe clinical periodontal disease and the relative abundance of periodontal bacteria in these at-risk individuals. Our results support the hypothesis that local inflammation at mucosal surfaces, such as the gums in this case, may provide the primary trigger for the systemic autoimmunity seen in RA.”

“We welcome these data in presenting concepts that may enhance clinical understanding of the key initiators of rheumatoid arthritis,” said Prof. Robert Landewé, Chairperson of the EULAR 2018 Scientific Programme Committee. “This is an essential step towards the ultimate goal of disease prevention.”

The study abstract is titled “An increased prevalence of periodontal disease, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in anti-CCP positive individuals at-risk of inflammatory arthritis".

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