Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Prevalence of Periodontitis, Anti-P. Gingivalis antibodies, and Rheumatoid Arthritis Autoantibodies in a Community Sample of North American Natives with Prevalent Rheumatoid Arthritis.
Schacter1, Isanne, Robinson1, David B., Hart2, Donna M., Bertone1, Mary, Peschken1, Christine A., Smolik3, Irene, Hitchon1, Carol A.
RA is prevalent and severe in North American Native (NAN) populations. We have studied risk factors for disease development in the Cree-Ojibway population of Central Canada and have previously shown that this population has an excessive burden of genetic risk factors for RA, particularly a high frequency of shared epitope (SE) encoding alleles. Environmental risk factors that have been shown to be associated with RA risk include smoking and the presence of periodontal disease, possibly in association with the oral pathogen P. gingivalis. We therefore sought to determine the prevalence of these risk factors in this population, and whether they are associated with the presence of RA autoantibodies and SE alleles.
We randomly surveyed two isolated NAN communities, Norway House (NH) (n=130) and St Theresa Point (STP) (n=172) Manitoba, for the prevalence of periodontal disease and RA autoantibodies. A dental hygienist performed an examination of the oral cavity in each study subject and quantified the degree of periodontitis using the standardized periodontal screening record (PSR) instrument having a scale ranging from 0 (no periodontitis) to 4 (severe periodontitis). Oral health symptoms, RA-like symptoms, and smoking history were captured using a questionnaire. Serum samples were tested for anti-P. gingivalis antibodies, anti-CCP2, and rheumatoid factor (RF). HLA-DRB1 testing was available for 100 study subjects in STP.
The demographic characteristics of the two study populations were comparable age (mean age 35.2 in NH, 34.7 in STP), as well as gender (55.2% female in NH, and 52.9% in STP). The mean PSR score in both communities was comparable (2.94 in NH, and 3.00 in STP, p=NS). Because of this, data from both communities was aggregated. Males had significantly worse PSR scores than females (3.17 versus 2.82, p<0.001). The only self-report symptom that correlated with PSR scores was the presence of bleeding gums (correlation = 0.130, p = 0.026). There was no correlation between the PSR scores and levels of anti-P. gingivalis (PSR>2 = 56 vs. PSR<3 = 58 ELISA units, p=NS). Anti-CCP2 and RF were detectable in (2.3% and 4.6%, respectively). Individuals who were anti-CCP2 or RF positive had comparable PSR scores. Although anti-P. gingivalis titres were comparable in CCP2+ and CCP2- individuals, RF+ individuals had significantly higher titres than RF negative individuals (66±19 vs 55±19, p=0.02). The prevalence of ever-smokers was very high in all groups (86.6%). PSR scores and anti-P. gingivalis titres did not differ between SE+ (91%) and SE- (9%) individuals, but all autoantibody positive individuals were also SE+
In a random sample of two NAN communities known to have a high prevalence of RA we demonstrated a high frequency of the known risk factors for the disease including SE, smoking, and periodontitis. Despite this, the frequency of RA autoantibodies in this community based sample was low, and there was no clear association with the study risk factors, including immune responses to anti-P. gingivalis. Thus, the interaction between these risk factors in predisposing to RA does not appear to be preceded by an increased overall frequency of anti-CCP or RF in this population.
To cite this abstract, please use the following information:
Schacter, Isanne, Robinson, David B., Hart, Donna M., Bertone, Mary, Peschken, Christine A., Smolik, Irene, et al; Prevalence of Periodontitis, Anti-P. Gingivalis antibodies, and Rheumatoid Arthritis Autoantibodies in a Community Sample of North American Natives with Prevalent Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :768