Gum Disease Risk 4 Times Greater in Patients With RA

Jenni Laidman

August 09, 2012

August 9, 2012 — Evidence of an association between gum disease and rheumatoid arthritis (RA) received a boost in a small study that found the odds of having gum disease to be 4 times greater among patients with RA.

The study, published online August 8 in the Annals of Rheumatic Diseases, lends further support to a hypothesis that the immune response to Porphyromonas gingivalis — a major pathogen in gum disease — can act as a trigger to RA in genetically susceptible people. Previous studies have shown an association between periodontal disease and advanced RA in patients receiving disease-modifying antirheumatic drugs (DMARDs). The current study is the first to look at nonsmokers who have never been treated with DMARDs, the authors write. (Smoking is associated with an increased risk for RA; therefore, smokers were excluded from the trial.)

Damodaram Potikuri, MD, from the Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India, and colleagues compared the gum health of 91 patients with RA, as defined by the American College of Rheumatology 1987 criteria, and 93 age- and sex-matched healthy control patients. The researchers measured mean pocket depth (MPD) at the roots of teeth, the concentration of anticitrullinated peptide antibodies (ACPAs), and titers of immunoglobulin M-rheumatoid factor (IgM-RF). Generation of citrullinated peptides is the body's normal response to gum disease but immune responses against these peptides is a "unique feature" of RA, occurring years before the onset of RA, the authors note.

The study found that participants with RA were 4.28 times (95% confidence interval, 2.35 - 7.80) more likely than healthy study participants to show evidence of periodontal disease (64.83% of patients with RA vs 28% of control patients; P < .001). MPD in patients with RA was greater, with an average depth of 3.61 ± 1.22 mm compared with 2.46 ± 0.74 mm in healthy control patients (P < .001). (An MPD of 3 mm or more indicates gum disease.)

IgM-RF titers were significantly higher in the RA cohort (110.56 ± 95.81 vs 66.53 ± 70.29 IU/mL; P = .02), as were ACPA titers (753.05 ± 1088.27 vs 145.15 ± 613.16 IU/mL; P = .001).

Further, researchers saw a positive correlation between MPD and ACPA titers (r, 0.24; P = .02). In patients with RA who were ACPA-positive, MPD was greater than in patients with RA who were ACPA-negative (3.94 ± 1.13 vs 3.40 ± 1.25 mm; P = .04), although both RA groups had significantly greater MPD than the control patients (2.46 ± 0.74 mm).

Although MPD was greater in patients with RA than in those without the disease, it did not differ significantly between IgM-RF-positive and IgM-RF-IGF-negative study participants (3.58 ± 1.10 vs 3.65 ± 1.40 mm; P = .8).

"Studies [have] shown that presence of ACPA is associated with severe RA," the authors write. "It could be expected that patients with [periodontal disease] may have severe RA and may tend to be more DMARD-resistant. However, further follow-up studies are essential to support this hypothesis and also the role of treatment of periodontitis in RA patients on disease activity."

This study was supported by the Indian Council of Medical Research. The authors have disclosed no relevant financial relationships.

Ann Rheum Dis. 2012;71:1541-1544. Abstract

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