Oral status in patients with early rheumatoid arthritis: a prospective, case–control study
TL;DR: Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore it is proposed that the consulting rheumatologists inform the patients that they have a higher risk ofperiodontal disease.
Abstract: Objective. Patients with RA suffer from a higher risk of periodontal attachment loss and increased oral inflammation. We hypothesize that there are pathogenetic and immunological interactions between these diseases that go beyond impaired manual dexterity accompanying advanced RA. The primary objective of the present study was to determine whether a loss of alveolar bone can be detected in RA patients during the early course of the disease. Methods. In this cross-sectional, epidemiological casecontrol study, 22 patients with early RA (ERA) were compared with 22 matched healthy controls. Oral and periodontal status, clinical activity, and sociodemographic parameters were determined. Oral microbiota were analysed using real-time quantitative PCR specific for leading oral pathogens. Results. More advanced forms of periodontitis were found in ERA patients compared with controls. ERA patients had a greater number of missing teeth [ERA 5.7 (S.D. 5.0), controls 1.9 (S.D. 1.0), P = 0.002], deeper periodontal pockets [clinical attachment level: ERA 3.4 (S.D. 0.5 mm), controls 2.7 (S.D. 0.3 mm), P < 0.000], and greater bleeding on probing [ERA 18.6% (S.D. 9.0%), controls 10.5% (S.D. 5.1%), P = 0.001] despite comparable oral hygiene. Tannerella forsythia (6.77-fold, P = 0.033) subgingivally and Streptococcus anginosus (3.56-fold, P = 0.028) supragingivally were the characteristic pathogens in ERA. Conclusion. Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore we propose that the consulting rheumatologists inform the patients that they have a higher risk of periodontal disease. It would be beneficial if these patients were referred directly for intensive dental care.
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TL;DR: In this paper, a study was performed to determine a possible relation between the severity of chronic periodontitis together with increased local inflammation of the periodontium and RA disease activity.
Abstract: Backgroud: Rheumatoid arthritis (RA) and chronic periodontitis are the most common chronic inflammatory diseases with remarkable pathological and clinical similarities
Aim: This study was performed to determine a possible relation between the severity of chronic periodontitis together with increased local inflammation of the periodontium and RA disease activity.
Methods: This study was conducted on 20 patients with Rheumatoid Arthritis fulfilling the 2010 ACR/EULAR classification criteria for RA. All subjects were recruited from those attending the Rheumatology Unit and Rheumatology outpatient clinic at the Alexandria main University Hospital. Rheumatoid disease activity was assessed by DAS-28 score system. The periodontal status was assessed by measuring PD, CAL, PI and GI. Local proinflammatory cytokines from the gingival crevicular fluid (GCF) were quantified including Il-6 and TNF-α. Correlations between different parameters were assessed using Spearman coefficient
Results: A positive correlation was found between DAS28 and both GCF IL-6 and TNF-α (p=0.694- r=0.001 ) and (p=0.604- r=0.005) for IL-6 and TNF- α respectively and the values were statistically significant. A positive correlation was also found between DAS28 and each of PD (p=0.246, r=0.297), CAL (p= 0.244, r=0.300), PI (p= 0.406, r= 0.076)and GI (p= 0.340,r= 0.142) however the correlation was not statistically significant.
Conclusion: The findings provide evidence of a possible relation between Rheumatoid Arthritis and chronic periodontitis through sharing the same inflammatory mechanism.
2 citations
TL;DR: The usefulness of sampling the oral microbiome in developing the diagnosis and prognostic treatment strategies for oral and systemic diseases to accelerate their clinical application is illustrated.
Abstract: Oral diseases are associated with systemic diseases; such as type II diabetes,
cardiovascular disease, rheumatoid arthritis (RA), and neurological diseases.
Coincidentally, the oral microbiome (fluids or extracts) is readily accessible and easily sampled; therefore,
serving as a diagnostic or prognostic tool for health status. The oral microbiome is a useful
research model for studying fundamental questions of the human microbiome. In
this narrative literature review, we examine the characteristics of oral microorganisms,
the relationship between oral microorganisms and human diseases, and the
important role of oral microorganisms in disease prevention. Also, we
illustrate the usefulness of sampling the oral microbiome in developing the
diagnosis and prognostic treatment strategies for oral and systemic diseases to
accelerate their clinical application. Selective saliva biomarkers and microbiome can serve for useful indices to oral diseases and systemic
diseases, and as a model research tool, the oral cavity has many uses in the
clinical and research environment. The relationships between oral health and
systemic diseases are quite profound, and future research will illuminate
opportunities for fruitful preventative measures and therapeutics.
2 citations
TL;DR: In this article , the role of Aggregatibacter actinomycetemcomitans (Aa) in the pathogenesis of pre-rheumatoid arthritis (RA) and RA patients is explained.
Abstract: Rheumatoid arthritis (RA) is a chronic autoimmune disease that symmetrically affects the joints, eventually leading to cartilage and tissue destruction. While there are multiple etiologies for RA, from environmental to genetic risk factors, periodontal disease (PD) may contribute to the acceleration of RA symptoms in pre-rheumatoid arthritis (pre-RA) and RA patients. While PD is caused by multiple oral bacteria, this review explains the role of Aggregatibacter actinomycetemcomitans (Aa) in the pathogenesis of pre-RA and RA based on 13 primary articles. This paper focuses on the Aa virulence factor leukotoxin A (LtxA) because it has been reported to cause cellular destruction and inflammation in the oral cavity that can accelerate the development of RA. Individuals who are classified as pre-RA may benefit from periodontal screening to further reduce their risk of developing advanced RA. Additionally, they may benefit from earlier pharmacological therapy for RA using disease-modifying anti-rheumatic drugs (DMARD) and antibacterial treatment.
2 citations
01 Jan 2015
TL;DR: It is can be concluded that oral health assessment is extremely useful in patients with, or at risk for developing rheumatoid arthritis, given the potential role of chronic bacterial infection of oral tissues in development, progression and disease activity of rhearatoid arthritis.
Abstract: There is currently much attention for early detection of rheumatoid arthritis, as early recognition enables timely treatment with a chance of remission of the disease before irreversible damage has occurred. In this respect, important questions are: who will develop rheumatoid arthritis, when and why? The main research question of this thesis was if chronic bacterial infection of oral soft- and hard tissues (periodontitis), in particular with the periodontal pathogen Porphyromonas gingivalis, predisposes to production of auto-antibodies specific for (the onset of) rheumatoid arthritis. Besides periodontitis, chronic inflammation of lung mucosal tissues has also been suggested to predispose to rheumatoid arthritis associated auto-antibody production. Indeed, presence of these auto-antibodies in patients without rheumatoid arthritis was associated with oral- or lung mucosal inflammation, although overall levels were low. Anti-Porphyromonas gingivalis antibody levels were not prognostic for development of rheumatoid arthritis. From this observation however, it cannot be concluded that there is no causal relationship between periodontitis and rheumatoid arthritis. Moreover, animal experiments confirm the suggested role of Porphyromonas gingivalis in development of human rheumatoid arthritis. Periodontitis is more prevalent among patients with rheumatoid arthritis. In addition, severity of periodontitis is correlated with rheumatoid arthritis disease activity. From this thesis is can be concluded that oral health assessment is extremely useful in patients with, or at risk for developing rheumatoid arthritis, given the potential role of chronic bacterial infection of oral tissues in development, progression and disease activity of rheumatoid arthritis.
1 citations
TL;DR: In this paper , the authors investigated whether periodontal bacteria could affect rheumatoid factor (RF) status in mice with preclinical, new-onset, or chronic RA, and investigated the subgingival microbiome via 16S rRNA sequencing.
Abstract: Abstract Association between exposure to periodontal bacteria and development of autoantibodies related to rheumatoid arthritis (RA) has been widely accepted; however, direct causal relationship between periodontal bacteria and rheumatoid factor (RF) is currently not fully understood. We investigated whether periodontal bacteria could affect RF status. Patients with preclinical, new-onset, or chronic RA underwent periodontal examination, and investigation of subgingival microbiome via 16S rRNA sequencing. Degree of arthritis and RF induction was examined in collagen-induced arthritis (CIA) mice that were orally inoculated with different periodontal bacteria species. Subsequently, single-cell RNA sequencing analysis of the mouse spleen cells was performed. Patients with preclinical RA showed an increased abundance of the Porphyromonadacae family in the subgingival microbiome compared to those with new-onset or chronic RA, despite comparable periodontitis severity among them. Notably, a distinct subgingival microbial community was found between patients with high-positive RF and those with negative or low-positive RF ( p =0.022). Oral infections with the periodontal pathogens P. gingivalis and Treponema denticola in CIA mice similarly enhanced arthritis score, but resulted in different levels of RF induction. Genes related to B cell receptor signaling, B cell proliferation, activation, and differentiation, and CD4 + T cell costimulation and cytokine production were involved in the differential induction of RF in mice exposed to different bacteria. In summary, periodontal microbiome might shape RF status by affecting the humoral immune response during RA pathogenesis.
1 citations
References
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Medical University of Vienna1, Boston University2, Arthritis Research UK3, Johns Hopkins University4, University of California, San Francisco5, Charité6, University of Toronto7, National Jewish Health8, Harvard University9, University of Paris10, University of Leeds11, Catholic University of the Sacred Heart12, Erasmus University Rotterdam13, University of Colorado Denver14, Leiden University15, University of California, San Diego16, University of Massachusetts Medical School17, University of Michigan18, University of Washington19, McGill University20, University of Pittsburgh21, Ministry of Health (New Zealand)22, New York University23, University of Manchester24, University of Amsterdam25
TL;DR: This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features.
Abstract: Objective The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. Methods A joint working group from the ACR and the European League Against Rheumatism developed, in three phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease—this being the appropriate current paradigm underlying the disease construct ‘RA’. Results In the new criteria set, classification as ‘definite RA’ is based on the confirmed presence of synovitis in at least one joint, absence of an alternative diagnosis better explaining the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in four domains: number and site of involved joints (range 0–5), serological abnormality (range 0–3), elevated acute-phase response (range 0–1) and symptom duration (two levels; range 0–1). Conclusion This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimise the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct ‘RA’.
5,964 citations
TL;DR: How the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics is summarized.
Abstract: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classi- fication system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics.1 Subsequently, a simpler classification was agreed upon at the 1st European Workshop in Periodontology.2 These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings including: 1) considerable overlap in disease categories, 2) absence of a gingival disease component, 3) inappropriate emphasis on age of onset of disease and rates of progression, and 4) inadequate or unclear classification criteria. The 1993 Europea...
4,653 citations
TL;DR: The purpose of the present investigation was to attempt to define communities using data from large numbers of plaque samples and different clustering and ordination techniques, which related strikingly to clinical measures of periodontal disease particularly pocket depth and bleeding on probing.
Abstract: It has been recognized for some time that bacterial species exist in complexes in subgingival plaque. The purpose of the present investigation was to attempt to define such communities using data from large numbers of plaque samples and different clustering and ordination techniques. Subgingival plaque samples were taken from the mesial aspect of each tooth in 185 subjects (mean age 51 +/- 16 years) with (n = 160) or without (n = 25) periodontitis. The presence and levels of 40 subgingival taxa were determined in 13,261 plaque samples using whole genomic DNA probes and checkerboard DNA-DNA hybridization. Clinical assessments were made at 6 sites per tooth at each visit. Similarities between pairs of species were computed using phi coefficients and species clustered using an averaged unweighted linkage sort. Community ordination was performed using principal components analysis and correspondence analysis. 5 major complexes were consistently observed using any of the analytical methods. One complex consisted of the tightly related group: Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola. The 2nd complex consisted of a tightly related core group including members of the Fusobacterium nucleatum/periodonticum subspecies, Prevotella intermedia, Prevotella nigrescens and Peptostreptococcus micros. Species associated with this group included: Eubacterium nodatum, Campylobacter rectus, Campylobacter showae, Streptococcus constellatus and Campylobacter gracilis. The 3rd complex consisted of Streptococcus sanguis, S. oralis, S. mitis, S. gordonii and S. intermedius. The 4th complex was comprised of 3 Capnocytophaga species, Campylobacter concisus, Eikenella corrodens and Actinobacillus actinomycetemcomitans serotype a. The 5th complex consisted of Veillonella parvula and Actinomyces odontolyticus. A. actinomycetemcomitans serotype b, Selenomonas noxia and Actinomyces naeslundii genospecies 2 (A. viscosus) were outliers with little relation to each other and the 5 major complexes. The 1st complex related strikingly to clinical measures of periodontal disease particularly pocket depth and bleeding on probing.
4,143 citations
Journal Article•
TL;DR: The origin of indices for recording gingivitis and plaque is reviewed and the use of the site prevalence of a single finding is suggested, which could be used as a clinically relevant parameter for oral hygiene and gingival inflammation.
2,554 citations
TL;DR: Examination systems for oral hygiene status use either selected teeth or the highest score for a group of teeth within a segment as the basis for their scores, which are of limited value for the clinician treating an individual patient.
Abstract: A N U M B E R OF examination systems have been developed to record the oral hygiene status of an individual. Most systems use either selected teeth or the highest score for a group of teeth within a segment as the basis for their scores. When used for epidemiological studies or for evaluating the results of treatment in a study group these methods yield useful information. A numerical score, however, is of limited value for the clinician treating an individual patient. He is concerned with the locations where plaque accumulates and in the patient's progress in learning how to effectively clean these surfaces.
2,135 citations