Background Studies suggest that periodontal disease may be a risk factor for rheumatoid arthritis (RA). Anti-citrullinated peptide/protein antibodies (ACPA) are highly specific for rheumatoid arthritis and ACPA epitope spreading arises several years prior to onset of clinical features of the disease.
Objectives To determine the immune reactivity to citrullinated antigens in patients with and without periodontal disease.
Methods ACPA serology was determined in patients with and without periodontal disease, which was diagnosed by periodontal examination and/or radiographs. In addition to anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV), we tested for antibodies with specificity for different citrullinated peptides, including vimentin (cit-vim), fibrinogen (cit-fib) and their uncitrullinated forms (vim and fib, respectively), as well as the citrullinated α-enolase peptide-1 (CEP-1) and its arginine-containing control peptide (REP-1). Multiple regression models were used to evaluate differences in ACPA response between individuals with and without periodontal disease, adjusting for potential confounders such as age, sex and smoking.
Results The sample included 96 (49%) patients with periodontal disease and 98 (51%) without periodontal disease, none of whom had rheumatoid arthritis at inclusion. Compared with patients without periodontitis, presence of periodontal disease was associated with higher median levels of the citrullinated peptides CEP-1 (4.45 vs. 6.45; p<0.001) and cit-vim (4.7 vs. 6.5; p<0.001), and their uncitrullinated controls, REP-1 (0.079 vs. 0.154; p<0.001) and vim (2.4 vs. 3.65; p<0.0001), in bivariate analysis. There was no difference between groups in the response against cit-fib; however, antibody levels against fib, its uncitrullinated form, were also higher in patients with periodontitis compared with patients without periodontitis (0.178 vs. 0.104, respectively; p<0.001). After adjusting for age, sex and smoking, patients with periodontitis had 68% (p=0.007), 49% (p=0.04) and 51% (p=0.03) higher anti-CEP-1, anti-REP1 and anti-fib antibody titres, compared with patients without periodontitis.
Conclusions In patients without rheumatoid arthritis, periodontitis may be associated with higher titres of antibodies to both citrullinated and uncitrullinated peptides. This findings warrant longitudinal studies to define the nature and causality of the association between periodontal disease and rheumatoid arthritis.
Disclosure of Interest None Declared
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