Background Spondyloarthritis (SpA) are a group of interconnected inflammatory arthritides that include ankylosing spondylitis (AS), reactive arthritis (ReA), and undifferentiated SpA (uSpA). Periodontal disease (PD) is a chronic inflammatory disease that may increase the risk for immune diseases like rheumatoid arthritis and AS.
Objectives To evaluate the periodontal condition and presence of Porphyromona gingivalis (P. gingivalis) and P. gingivalis IgG1 and IgG2 antibodies within three subgroups of SpA (AS, uSpA and ReA) and establish possible associations with disease activity measures.
Methods A cross-section observational study was designed. Seventy-nine subjects were included (AS: 19, ReA: 14 and uSpA: 46). Clinical evaluation of rheumatologic and periodontal condition was performed. P. gingivalis presence by polymerase chain reaction (PCR) and P. gingivalis IgG1 and IgG2 antibodies as well as erythrocyte sedimentation rate (ESR), high sensitive C reactive protein (hsCRP), rheumatoid factor, cyclic citrullinated peptide antibody (ACPAs), HLA-B27 and disease activity measures were assessed. A descriptive analysis of frequency distributions for clinical, laboratory and demographic data was made. Associations between clinical and microbiological markers of P. gingivalis infection, including IgG1 and IgG2 antibodies, and SpA disease activity measures were evaluated. Chi-squared test was performed to determine associations. Comparisons between groups were made with Kruskal Wallis, Mann-Whitney U and Wilcoxon test. The study was approved by local ethics committee.
Results Forty-four (55.7%) patients with SpA presented PD, of which uSpA had a higher frequency (65.2%). Most patients had moderate PD (AS: 26.3%, uSpA: 50.0%, ReA: 21.4%). A high frequency of retired uSpA patients (87.5%) had moderate PD (p=0.044). The clinical attachment level (CAL) ≥4mm (8.1 ± 10.5) and % of CAL ≥4mm (5.7 ±7.7) was more frequent in uSpA patients (p=0.033 and p=0.034 respectively). P. gingivalis presence in uSpA patients was associated with the use of sulfasalazine (p=0.017), and in retired patients (p=0.028). In AS patients, positive IgG1 to P gingivalis was associated with % periodontal pocket depth ≥4mm (p=0.04) and % sites with sample pocket depth (SPD) ≥4mm (p=0.02). Also in this subtype, positive IgG2 was associated with bacterial plaque index (p=0.03). Positive levels of IgG2 in uSpA were associated with bleeding of probing (BOP) (p=0.03) and the number of compromised periodontal interproximal sites (p=0.05). See Table 1.
Conclusions We found a high frequency of PD in patients with SpA without significant statistical differences between each subtype. The differences in clinical periodontal variables in SpA subtypes probably suggest a better oral hygiene in these patients. P. gingivalis IgG antibodies may be a useful tool for the physician to assess periodontal condition in these patients.
Disclosure of Interest None declared
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