Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
TNF Blockage in Spondyloarthritis: Induction of Alveolar Bone Growth in Teeth with Periodontal Disease?
Fabri1, Gisele Maria Campos, Savioli2, Cynthia, Saad5, Carla G. S., Calich5, Ana Luisa Garcia, Moraes5, Julio Cesar Bertacilli, Ribeiro5, Ana Cristina Medeiros, Carvalho5, Jozélio Freire
Dentistry and Rheumatology Division (CEDMAC), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Dentistry and Rheumatology Division (CEDMAC), Faculdade de Medicina da Universidade de São Paulo
Dentistry Division, Faculdade de Medicina da Universidade de São Paulo
Paediatric Rheumatology Unit, Rheumatology Division (CEDMAC), Faculdade de Medicina da Universidade de São Paulo
Rheumatology Division (CEDMAC), Faculdade de Medicina da Universidade de São Paulo
Previous studies have shown that patients with spondyloarthritis (SpA) have a significant higher risk of periodontal disease (PD). SpA also can induce periosteal bone formation suggesting that the impact of inflammation on bone is specific to the site at which inflammation occurs. We therefore have evaluated the local effect of TNF-antagonist therapy in PD of SpA patients.
Nineteen SpA patients (ESSG criteria) were prospectively evaluated at baseline(BL) and after 6 months(6M) of anti-TNF therapy. A dentist performed systematic periodontal assessment that included: clinical measurements of periodontal disease severity [probing pocket depth(PPD), cementoenamel junction(CEJ), clinical attachment level(CAL)], gingival inflammation (gingival bleeding index), and oral hygiene (plaque index). All patients were examined by a rheumatologist, blinded to dentist assessment, in order to evaluate demographic data and outcome measures (BASDAI, BASMI, BASFI, ASQoI, CRP, ESR).
Eleven patients (58%) were male, with median age 45(2061) years and median disease duration 8(141) years. Infliximab was used by 12(63%) patients, adalimumab by 6, and etanercept by 1. CRP (16 vs. 4.2mg/L, p=0.003), BASDAI (5.25 vs. 2.65, p=0.001) and BASFI (5.25 vs. 1.95, p=0.017) improved significantly at 6M. No differences were observed in the median of clinical measurements of periodontal disease severity, gingival inflammation and oral hygiene 6M after TNF antagonist use in the whole group. Eight patients (42%) had PD; in these patients, the periodontal assessment of all teeth showed no differences in the median of plaque, gingival bleeding indices, PPD, CEJ, CAL at BL versus 6M period (p>0.05). However, the specific longitudinal analysis of teeth with periodontal disease revealed that only PPD had a significant improvement comparing BL versus 6M visit [3.67 (3.84.27) vs. 2.77mm (2.473.03), p=0.003] whereas CEJ [0.53 (-0.582.03) vs. 1.66mm (-0.742.04), p=1.0] and CAL [3.98 (2.835.93) vs. 3.54mm (2.094.7), p=0.130] remained stable; this isolated PPD improvement without change in other PD measurements suggests a local bone formation. Despite the PPD improvement, there was no significant resolution of the local inflammation after 6M of anti-TNF therapy, as demonstrated by the persistence of plaque [75.3 vs. 79.8%, p=0.749] and gingival bleeding index [52.4 vs. 39.6%, p=0.641].
This study suggests that blockade of TNF activity in SpA patients with periodontal disease may induce a local bone growth. The most likely mechanism underlying this process is a persistent periodontal inflammation disrupting local bone remodeling.
To cite this abstract, please use the following information:
Fabri, Gisele Maria Campos, Savioli, Cynthia, Saad, Carla G. S., Calich, Ana Luisa Garcia, Moraes, Julio Cesar Bertacilli, Ribeiro, Ana Cristina Medeiros, et al; TNF Blockage in Spondyloarthritis: Induction of Alveolar Bone Growth in Teeth with Periodontal Disease? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2078