PHYSICS AND CHEMICAL, IMMUNOENZYME AND BIOCHEMICAL INDICATORS OF ORAL FLUID IN PERIODONTITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Infection with comorbid periodontitis due to transient bacteremia in patients with rheumatoid arthritis (RA) can lead to microbial colonization outside the mouth and increase systemic immune inflammation. Periodontitis-induced endotoxemia increases the sensitivity of RA patients to autoantigens by activating membrane proteins, pro-inflammatory enzymes, and cytokines. RA and periodontitis have similar osteoclasia, allelic genes and general imbalance in the state of the cytokine network, and carbamylation of proteins and the formation of extracellular traps of neutrophils are associated with simultaneous autoimmune imbalance in the combination of RA and periodontitis, but the listed pathogenetic mechanisms require further study.
The purpose and objectives of the study: to study the properties of the oral fluid in periodontitis in patients with RA, to determine the clinical and pathogenetic significance of changes in physicochemical, enzyme immunoassay and biochemical parameters in the pathology of the oral cavity and joints, to compare the indicators with the nature of the gingival microbiota.
Material and methods. The study included 173 RA patients aged 18-76 years (average 46 years), among whom there were 21% of men and 79% of women. The duration from the first manifestation of the disease averaged 10 years. The frequency of RA seropositivity for rheumatoid factor in the blood was 75%, and for antibodies to citrulline cyclic peptide was 73%. The І, ІІ and ІІІ degrees of disease activity, respectively, were stated in 26%, 44% and 30% of cases, and the ratio of I, II, III and IV stages of the pathological process was 1: 6: 5: 3.
Results. We studied the physicochemical adsorption-rheological properties of the oral fluid (surface tension, viscoelasticity, relaxation), the levels of pro-inflammatory cytokines in it, the concentration of aminopeptide, peptide, nucleotide and chromatophore fractions of average weight molecules, the ratio with similar parameters in blood serum. To assess the number of aerobic and facultative anaerobic microorganisms vegetating on the gingival mucosa, the method of sterile paper discs was used. Compared with healthy people in the control group, 99% of the number of RA patients has an increase in the concentration of interleukin 1b in the oral fluid (22 times), 98% of tumoronecrotic factor a (7 times), 43% of the average increase in the average weight molecules (by 47%), at the same time, the parameters are associated with the presence of secondary Sjogren's syndrome, with the severity of the course of both articular syndrome, and periodontitis, which is accompanied by a longer relaxation time of oral washings (by 36%), but their lower interfacial activity (by 11%), the ratio of the tumor necrosis factor parameter a with the level of this pro-inflammatory cytokine in the blood (by 70%), and there are dispersion relationships of individual indicators of the oral fluid with the vegetation on the gums of bacterioids, bifidobacteria, Escherichia coli, megaspheres, moraxellas, neisseria, propionibacteria, proteus, pseudomones, sarcins and streptococcus.
Conclusions: the obtained data dictate the need to develop new approaches to medical technology for individual pathogenetic therapy of chronic generalized periodontitis, taking into account its etiology in RA patients, identifying criteria that allow assessing the activity of the pathological process, predicting the nature of the course of the disease and the effectiveness of treatment measures.
2. Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res. 2018;4(3):265-72. doi: 10.1186/ar578.
3. Oton T, Carmona L. The epidemiology of established rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2019;33(5):101477. doi: 10.1016/j.berh.2019.101477.
4. Ouedraogo DD, Tiendrebeogo J, Guiguimde PL. Periodontal disease in patients with rheumatoid arthritis in SubSaharan Africa: A case-control study. Joint Bone Spine. 2017;84(1):113-4. doi: 10.1016/j.jbspin.2016.02.014.
5. Havemose-Poulsen A, Sorensen LK, Stoltze K. Cytokine profiles in peripheral blood and whole blood cell cultures associated with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis. J Periodontol. 2015;76(12):2276-85. doi: 10.1902/jop.2015.76.12.2276.
6. Graves DT, Corrêa JD, Silva TA. The oral microbiota is modified by systemic diseases. J Dent Res. 2019;98(2):148-56. doi: 10.1177/0022034518805739.
7. Konkel JE, O'Boyle C, Krishnan S. Distal consequences of oral inflammation. Front Immunol. 2019;25(10):1403. doi: 10.3389/fimmu.2019.01403.
8. Kumar PS. From focal sepsis to periodontal medicine: a century of exploring the role of the oral microbiome in systemic disease. J Physiol. 2017;595(2):465-76. doi: 10.1113/JP272427.
9. Grevich S, Lee P, Leroux B, Ringold S, Darveau R, Henstorf G et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2019;17(1):81-9. doi: 10.1186/s12969-019-0387-5.
10. Rajkarnikar J, Thomas BS, Rao SK. Inter-relationship between rheumatoid arthritis and periodontitis. Kathmandu Univ Med J. 2018;11(41):22-6. doi: 10.3126/kumj.v11i1.11018.
11. Correa JD, Fernandes GR, Calderaro DC, Mendonça SMS, Silva JM, Albiero ML et al. Oral microbial dysbiosis linked to worsened periodontal condition in rheumatoid arthritis patients. Sci Rep. 2019;9(1):8379. doi: 10.1038/s41598-019-44674-6.
12. Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to mouth: a systematic review and meta-analysis of the association between rheumatoid arthritis and periodontitis. Front Immunol. 2016;2(7):80. doi: 10.3389/fimmu.2016.00080.
13. Correa MG, Pires PR, Ribeiro FV, Pimentel SP, Cirano FR, Napimoga MH et al. Systemic treatment with resveratrol reduces the progression of experimental periodontitis and arthritis in rats. PLoS One. 2018;13(10):0204414. doi: 10.1371/journal.pone.0204414.
14. Gamel EB, Hashim NT, Satti A, Gismalla BG. Salivary TNFα levels in groups of subjects with rheumatoid arthritis and chronic periodontitis. BMC Res Notes. 2017;10(1):34-9. doi: 10.1186/s13104-016-2341-7.
15. Li R, Tian C, Postlethwaite A, Jiao Y, Garcia-Godoy F, Pattanaik D et al. Rheumatoid arthritis and periodontal disease: What are the similarities and differences? Int J Rheum Dis. 2017;20(12):1887-901. doi: 10.1111/1756-185X.13240.
16. Issaranggun Na Ayuthaya B, Everts V, Pavasant P. The immunopathogenic and immunomodulatory effects of interleukin-12 in periodontal disease. Eur J Oral Sci. 2018;126(2):75-83. doi: 10.1111/eos.12405.
17. Eriksson K, Fei G, Lundmark A, Benchimol D, Lee L, Hu YOO et al. Periodontal health and oral microbiota in patients with rheumatoid arthritis. J Clin Med. 2019;8(5):630. doi: 10.3390/jcm8050630.
18. Möller B, Kollert F, Sculean A, Villiger PM. Infectious triggers in Periodontitis and the gut in rheumatoid arthritis (RA): A complex story about association and causality. Front Immunol. 2020;11(3):1108. doi: 10.3389/fimmu.2020.01108.
19. Gordeev AV, Galushko EA, Savushkina NM, Lila AM. Is periodontitis a harbinger of rheumatoid arthritis? Rheumatol Sci Pract. 2018;56(5):613-21. doi.org/10.14412/1995-4484-2018-613-621.
20. Kuru B, McCullough MJ, Yilmaz S, Porter SR. Clinical and microbiological studies of periodontal disease in Sjögren syndrome patients. J Clin Periodontol. 2002;29(2):92-102. doi: 10.1034/j.1600-051x.2002.290202.x.
21. Pers JO, d'Arbonneau F, Devauchelle-Pensec V. Is periodontal disease mediated by salivary BAFF in Sjögren's syndrome? Arthritis Rheum. 2005;52(8):2411-4. doi: 10.1002/art.21205.
This work is licensed under a Creative Commons Attribution 4.0 International License.