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Clinical studies point towards an association between periodontitis and rheumatoid arthritis (RA).1 ,2 A pathogenic role is suggested for Porphyromonas gingivalis.3 P gingivalis may contribute to the pathogenesis of RA by breaking immune tolerance through formation of (bacterial and human) citrullinated proteins, leading to anticitrullinated protein antibody production (ACPA).4 ,5 Since ACPA production precedes RA development6 and because P gingivalis IgG antibodies are long-term stable in untreated periodontitis patients,7 we investigated whether anti-P gingivalis antibody levels are prognostic for development of RA, by assessing these antibodies in a cohort of 289 adults at risk for RA. Patients with arthralgia and seropositivity for IgM-rheumatoid factor (IgM-RF) and/or ACPA were selected from a prospective follow-up study on arthritis development.8 They are further referred to as seropositive arthralgia patients (SAP); their median follow-up was 30 months (IQR 13–49).
Baseline sera were used for measurement of ACPA, IgM-RF, C-reactive protein (CRP) and HLA-DRB1 SE carrier status.8 IgA, IgG and IgM antibody levels against P gingivalis were determined by in-house ELISA with a pooled lysate of clinical isolates of P gingivalis as …
Contributors Study conception and design: JW, EB, LAvdS and DvS. Acquisition of data: LAvdS, DvS, MdS, BD-vdM and KMJJ. Analysis and interpretation of data: MdS, KMJJ, EB, AJvW, AV, JW and DvS. Drafting of manuscript: MdS. Critical revision: AJvW, AV, EB, JW and DvS.
Funding This study was funded by the authors' institutions. The SAP cohort was supported by grants from the Netherlands Organization for Health Research and Development (ZonMw) (grant number 6100.0010) and the Dutch Arthritis Association (grant number 0801034).
Competing interests None.
Ethics approval Ethics Committee of the Slotervaart Hospital and the Jan van Breemen Institute, Amsterdam, The Netherlands.
Provenance and peer review Not commissioned; externally peer reviewed.
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