OP0104 THE ASSOCIATION BETWEEN PERIODONTAL DISEASE AND JOINT DESTRUCTION IN RHEUMATOID ARTHRITIS PATIENTS EXTENDS THE LINK BETWEEN THE HLA-DR SHARED EPITOPE AND BONE DESTRUCTION SEVERITY
H. Marotte, P. Farge, P. Gaudin, C. Alexandre, B. Mougin, P. Miossec

Both rheumatoid arthritis (RA) and periodontal disease (PD) are inflammatory diseases that lead to bone destruction. There is evidence both diseases have some genetic factors in common. The purpose of this abstract is to evaluate possible associations between RA and PD.

RA patients from the Rohne-Alpes area were enrolled. Joint damage at the wrist was defined as a right wrist Larsen score > 2. Periodontal damage was defined by an alveolar bone loss with a horizontal alveolysis over 1/3 of the normal bone height using the Hugoson and Jordan criteria on panoramic dental x-rays. HLA-DRB1 typing was done. Correlations were quantified using chi squared ( χ2 ) analysis , odds ratios (OR), and relative risk (RR).

Results: 147 RA patients were enrolled.

• 63 with both wrist and periodontal destruction
• 31 with only wrist destruction
• 20 with only periodontal destruction
• 33 had neither wrist nor periodontal destruction

A correlation (χ=11.82; p<(<0.001) was found between wrist and periodontal bone destruction. In positive labial salivary gland biopsy correlated with periodontal destruction (RR=2.73; 95% C.I. 1.35, 5.51, p<0.01, n=41) and with wrist destruction (RR=4.52; 95% C.I. 1.96, 10.45, p<0.001, n=41). Additionally, the presence of the shared epitope was also associated with bone destruction in both the wrist (OR=2.5; 95% C.I. 1.16, 5.42, p<0.05) and periodontal (OR=2.2; 95% C.I. 1.04, 4.84, p<0.05).

Conclusion: These data indicate an association between wrist and periodontal bone destruction in RA patients, particularly in patients with sicca syndrome.

Editorial Comments: Several studies have suggested an increased prevalence of periodontal disease in patients with rheumatoid arthritis. Periodontal disease represents an inflammatory process initiated by bacterial infection, but driven by many of the same proinflammatory mediators seen in RA including TNF, IL1, and matrix metalloproteinases. In severe cases of periodontal disease, like erosive RA, a process of matrix degradation and bone loss occurs.

In this study panoramic Xrays of the mouth to evaluate alveolar bone loss and XRays of the wrist to look for erosions were performed in a group of RA patients. The study demonstrated correlation between bone loss at both sites, suggesting a possible relationship between these two disease processes. Interestingly the shared epitope was associated with periodontal destruction, and the presence of Sicca and Sjogrens was also an apparent risk for bone loss in the joint and mouth. It is notable however that many patients in this cohort of RA patients had periodontal bone loss without wrist erosions, but it is unknown if a more sensitive imaging modality or an assessment of erosive disease at other sites in these patients would have shown damage. Details on the clinical characteristics of the RA patients and periodontal assessments were not provided.

Whether patients with RA are at increased risk for the development of periodontal disease, whether periodontal disease is a risk for the development of RA, or whether the bony destruction seen in patients with both conditions represents an upregulated generalized systemic inflammatory response process is not clear from this data. However, the associations demonstrated in this study raise significant questions amenable to further exploration of interrelationships between oral health and rheumatoid arthritis.

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