Gum Disease Prominent in RA,TNF-Blockade Can Help | Arthritis Information

 

COPENHAGEN, Denmark—Three new studies help shed light on the connection between rheumatoid arthritis (RA) and periodontitis, and new data help define the role of TNF-blockade in treating both. The research was presented at EULAR Congress in Copenhagen, Denmark.¹

Gum disease ups risk of RA in non-smokers

Despite the fact that smoking is a known risk factor for RA, “moderate to severe periodontitis may be a risk factor for the development of RA in non-smokers. Individuals with moderate to severe periodontitis have higher anti-citrullinated protein antibody (ACPA) titers than those with no or mild periodontitis, suggesting that periodontitis may be an important environmental trigger for seropositive RA,” concluded researchers who were led by Jerry A. Molitor, MD, PhD, a rheumatologist at the University of Minnesota in Minneapolis.

In this study,¹ the researchers examined hospitalization discharge codes of 5,413 participants in the Atherosclerosis Risk in Communities (ARIC) study for whom they had serum samples taken at the time of a detailed periodontal assessment in 1996-1998.

Participants who were hospitalized with RA in the 9 years before their periodontal exam were designated as having “prevalent” RA, while those with a first-time RA discharge code up to 8 years following their periodontal assessment were designated as having “incident” RA. Researchers analyzed the blood of the RA cases.

Incidence rates of hospitalization with an RA diagnosis was 1.1 per 1000 persons per year (female) and 0.8 per 1000 persons per year (male). The hazards ratio of developing RA in subjects with moderate to severe periodontitis was 2.6, compared to those with no to mild periodontitis. The hazard ratio for developing RA was 8.8 among lifetime non-smokers, the study showed. Gum disease severity was not independently associated with RA incidence among current and former smokers, according to the ARIC data. ACPA levels were significantly higher in participants with moderate-severe periodontitis than in those with no-mild periodontitis, the researchers report.

More than half of RA patients have gum disease, TNF-blockade to the rescue

Fully 56% of RA patients also have periodontitis, according to second study presented at EULAR.² These individuals were missing teeth, had a high prevalence of sites with dental plaque in their mouths, advanced attachment loss and higher levels of inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate (ESR) as well as immune system abnormalities such as the presence of anti-citrullinated protein antibodies, compared to RA-free controls.

TNF-blockade improved some of these periodontal changes within 6 months. “Anti-TNF’s are potentially able to modulate the inflammatory process in the periodontium,” the study authors write.

In a related, confirmatory report,³ a team of Israeli researchers found that RA patients who are treated with infliximab show improvements in their periodontal health. Specifically RA patients treated with this TNF-blocker showed lower levels of TNF, gingival cervicular fluid, and less gum disease than RA patients who did not receive infliximab, the study showed.

“Anti-TNF alpha agents may influence both the destruction processes (probing depth and clinical attachment loss) and the vascular reactions (bleeding on probing and gingival index),” the researchers write. “Thus suppression of pro-inflammatory cytokines may be beneficial in the suppressing of periodontal inflammation and destruction.”

References

1. Molitor JA, Alonso Am Wener MH, et al. Moderate to severe adult periodontitis is associated with increased risk of seropositive rheumatoid arthritis in non-smokers : The ARIC study.. Presented at: EULAR 2009, June 10-13, 2009; Copenhagen, Denmark. Abstract FRI0129.
2. Ancuta X, Ioedache C, Ancuta E, et al. Periodontal status in patients with rheumatoid arthritis. Presented at: EULAR 2009, June 10-13, 2009; Copenhagen, Denmark. Abstract FRI0171.
3. Mayer Y, Machtei E, Balbir-Gurman A. Periodontal health in rheumatoid arthritis patients treated with infliximab. Presented at: EULAR 2009, June 10-13, 2009; Copenhagen, Denmark. Abstract  ABO152.

thanks Lynn!! [QUOTE=babs10]thanks Lynn!! [/QUOTE]