Key clinical point: The presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies was significantly associated with more severe periodontal outcomes in rheumatoid arthritis (RA) patients.

Major finding: Several signs of severe periodontal disease, including plaque index and clinical attachment levels, were significantly higher among RA patients and these severity parameters were associated with higher levels of anti-CCP antibodies.

Study details: The data come from an observational, cross-sectional study of 164 adult RA patients.

Disclosures: The study was supported in part by the Spanish Ministry of Health, the European Regional Development Fund, and REUNINVES Asociación. The researchers had no financial conflicts to disclose.

Commentary

“As the presence of anti-citrullinated peptide antibodies (ACPAs) in RA are thought to be related to the pathogenesis of the illness, the mechanism of initiation of ACPA formation is of great interest in understanding how RA develops. ACPAs are now understood to be in part related to tobacco use; the authors of this study investigate the association of ACPAs with periodontal disease. This single-center observational study looked at 164 RA patients in Spain and compared severity of periodontal disease to presence of absence of ACPAs. Several indices of periodontal disease were worse in ACPA positive vs ACPA negative patients, and this difference was independent of tobacco use as well as disease activity. While this study does not prove a causative relationship in RA pathogenesis, it suggests there is a connection with periodontal disease and ACPA. It would have been interesting to see whether the presence of sicca symptoms or Sjogren’s syndrome impacts this relationship, given the frequency of concomitant Sjogren’s syndrome with RA.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University