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: Self-reported oral conditions were associated with increased risk of self- reported arthritis, and oral hygiene habits were not associated with self-reported arthritis.
Abstract: We acknowledge the ScotCen Social Research, Scottish Government and the UK Data Archive for providing these data for research purposes. They bear no responsibility for any further analysis or interpretation. Hadeel Mohammed Abbood received funding from the Higher Committee for Education Development in Iraq (HCED-Iraq) to undertake her PhD. Hadeel Mohammed Abbood is grateful to Ms Shifa Sarica (Epidemiology Group, University of Aberdeen, UK) for help with manuscript editing. The authors declare no conflicts of interest related to this study. Although all efforts are made to ensure the quality of the materials, neither the original data creators, depositors, the funders of neither the data collections, nor the UK Data Archive bear any responsibility for the accuracy or comprehensiveness of these materials.
9 citations
Cites background or result from "Oral status in patients with early ..."
...Similarly, an association between periodontitis and musculoskeletal conditions has been suggested [6-9]....
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...However, these studies had relatively small sample sizes ranging from 15 patients and 10 controls to 290 patients and 49 controls [7-9]....
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...The finding of an association between bleeding gums and increased risk of arthritis was supported by several previous studies which showed an increase in bleeding on probing (during periodontal examination) in patients with RA compared to healthy controls [7-9]....
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...Oral diseases, particularly periodontitis, have been suggested to be associated with arthritis [6-9]....
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TL;DR: Age, female gender, ever-smoker status, fracture history, JHAQ-DI, and prednisolone dosage appeared to be associated with periodontal disease in Japanese patients with RA.
Abstract: Objectives: This study aimed to evaluate the prevalence of, and the factors associated with, periodontal disease in Japanese patients with rheumatoid arthritis (RA).Methods: Patients with RA enroll...
7 citations
Cites background from "Oral status in patients with early ..."
...Since advanced forms of periodontitis have been diagnosed in the early stages of RA [27], periodontitis may be more severe in young rather than old patients with RA....
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TL;DR: Prevotella and Alloprevotella species were enriched in patients with early RA independent of severity of periodontitis and further studies are needed to test a causal relationship of these species with onset and/or disease progression of RA.
Abstract: Background We previously showed that in this early rheumatoid arthritis (ERA) cohort with a mean disease duration of Objectives To characterize the oral microbiome associated with ERA. Methods 16S amplicon sequencing was used to analyze 88 samples of the supragingival and subgingival microbiome of 22 patients with ERA and 22 matched healthy controls. Oral and periodontal status, clinical activity of ERA and periodontitis, and socio-demographic parameters were used as explanatory variables in the next generation DNA sequencing analysis. Results Overall, a total of 4.702.161 16S RNA high-quality sequences were yielded. Using a distance-based similarity of >97% for species-level operational taxonomic unit (OTU) assignment, a total of 1054 OTUs were identified (Fig 1). The oral microbiota was equally rich and diverse in ERA and control group. Subgingivally, Prevotella oris, Prevotella oralis, Prevotella nigrescens, Alloprevotella rava and Alloprevotella tannerae were associated with early RA independent of severity of periodontitis. Conclusions Prevotella and Alloprevotella species were enriched in patients with early RA independent of severity of periodontitis. Further studies are needed to test a causal relationship of these species with onset and/or disease progression of RA. References Oral status in patients with early rheumatoid arthritis: a prospective, case-control study. Wolff B, Berger T, Frese C, Max R, Blank N, Lorenz HM, Wolff D. Rheumatology (Oxford). 2014 Mar;53(3):526–31. The lung microbiota in early rheumatoid arthritis and autoimmunity. Scher JU, Joshua V, Artacho A, Abdollahi-Roodsaz S, Ockinger J, Kullberg S, Skold M, Eklund A, Grunewald J, Clemente JC, Ubeda C, Segal LN, Catrina AI. Microbiome. 2016 Nov 17;4(1):60. Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. Scher JU, Sczesnak A, Longman RS, Segata N, Ubeda C, Bielski C, Rostron T, Cerundolo V, Pamer EG, Abramson SB, Huttenhower C, Littman DR. Elife. 2013 Nov 5. Acknowledgements Wolff and Boutin contributed equally. Disclosure of Interest None declared
7 citations
TL;DR: This patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings and is proposed to use as a measure of periodontitis without applying cut-off values.
Abstract: The aim of this study was to develop a patient-reported questionnaire that is suitable to detect periodontitis (PD) in patients with rheumatoid arthritis (RA). A self-reported questionnaire containing 12 items potentially relevant to PD and dentists’ semiquantitative assessment of PD (no/mild/moderate/severe) was obtained from 353 patients from an early arthritis cohort. Available radiographs (n = 253) and blinded assessment of 3 independent dentists were used for validation. By defining the dentists’ assessment as the reference standard, relevant questionnaire items were identified with factor analysis methods. Receiver operator characteristic (ROC) plots were used to determine sensitivities and specificities to detect PD in varying severity. Ordinal regression models were used to determine the coefficients for the final score. Seventy percent had at least mild PD. The items from the questionnaire correlating best with the dentists’ assessment were selected for a final 6-item score (number of teeth, gum pockets, receding gums, loose teeth, receding jaw bone and tooth extractions and age). For the detection of any/moderate/severe PD, the bias-corrected areas under the curve (AUC) were 0.81/0.83/0.90. Sensitivity to detect mild PD was 85% and specificity 57%. Very high specificity was achieved for the detection of severe PD with 99% at the cost of low sensitivity (28%). This patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings. We propose to use the score as a measure of periodontitis without applying cut-off values.
6 citations
Patent•
30 Sep 2014
TL;DR: In this article, metagenomic linkage groups (MLGs) have been identified and validated in gut and oral microbiotas to identify a subject suffering from RA or having risk of developing RA, monitoring the efficacy of an RA treatment in a subject, or selecting or modifying a treatment for an RA patient.
Abstract: Biomarkers for rheumatoid arthritis (RA) are described. RA-associated metagenomic linkage groups (MLGs) have been identified and validated in gut and oral microbiotas. These MLGs are used in systems, methods and products for identifying a subject suffering from RA or having risk of developing RA, monitoring the efficacy of an RA treatment in a subject, or selecting or modifying a treatment for an RA patient.
6 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