EXTENDED REPORT

The association between periodontal disease and joint destruction in rheumatoid arthritis extends the link between the HLA-DR shared epitope and severity of bone destruction

H Marotte¹, P Farge², P Gaudin³, C Alexandre⁴, B Mougin¹, P Miossec¹

¹ Hospices Civils de Lyon-bioMérieux Research Unit on Rheumatoid Arthritis, Lyon, France
² Faculty of Odontology, University Lyon I, Lyon, France
³ Grenoble Hospital, Grenoble, France
⁴ Saint-Etienne Hospital, Saint-Etienne, France

Correspondence to:
Professor P Miossec
Clinical Immunology Unit, Departments of Immunology and Rheumatology, Hôpital Edouard Hérriot, 69437 Lyon Cedex 03, France; miossec{at}univ-lyon1.fr

Objective: To evaluate a possible association between wrist and periodontal destruction in rheumatoid arthritis, and between periodontal destruction, dry mouth, and labial salivary gland biopsy and the contribution of genetic factors (the shared epitope (SE) and IL1B (+3954) or TNFA (–238 or –308) gene polymorphisms).

Methods: 147 patients with rheumatoid arthritis were enrolled. Periodontal damage was defined according to the Hugoson and Jordan criteria on panoramic dental x rays. Typing for the SE and cytokine polymorphisms was undertaken by enzyme linked oligosorbent assay. Odds ratios (OR), relative risk (RR), and ² values were calculated to quantify associations.

Results: An association was observed between wrist and periodontal bone destruction (² = 11.82; p<0.001): 63 patients had both wrist and periodontal destruction, 31 had wrist destruction alone, 20 had periodontal destruction alone, and 33 had no destruction at either site. An association was seen between a positive labial salivary gland biopsy and periodontal bone destruction (RR = 2.73 (95% CI, 1.35 to 5.51), p<0.01, n = 41) or wrist bone destruction (RR = 4.52 (1.96 to 10.45), p<0.001, n = 41). The SE was associated with wrist bone destruction (OR = 2.5 (1.16 to 5.42), p<0.05) and periodontal bone destruction (OR = 2.2 (1.04 to 4.84), p<0.05). No association was found between the selected cytokine polymorphisms and bone destruction.

Conclusions: A strong association was found between wrist and periodontal bone destruction. The destruction risk was further increased in patients with sicca syndrome. The SE appears to be a severity genetic marker for both wrist and periodontal bone destruction.

Abbreviations: DAS 28, 28 joint disease activity score; RF, rheumatoid factor; SE, shared epitope; SNP, single nucleotide polymorphism

Keywords: shared epitope; destruction; periodontal disease; rheumatoid arthritis; cytokines

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