â€œEffect of Non-Surgical Periodontal Therapy on Chronic Periodontitis and Rheumatoid Arthritis and a correlation of Anti-Citrullinated Protein Antibody (ACPA) levels in South Indian Population”

Introduction

Chronic periodontitis is found associated with a number of systemic conditions like diabetes mellitus, atherosclerosis, coronary heart disease and some chronic inflammatory disorders including rheumatoid arthritis. Among these, the association of rheumatoid arthritis with chronic periodontitis has been widely studied and researched.  Rheumatoid Arthritis (RA) and Chronic Periodontitis (CP) share certain common features like both being chronic inflammatory diseases associated with bone loss and destruction of the soft tissue surrounding the bone. Exacerbation of RA signs in patients with CP and incidence of increased CP in patients with RA also have been reported.

Many possible mechanisms have been proposed to explain the association of periodontitis and rheumatoid arthritis. Oral infections contributing to the pathogenesis of RA is one such theory.

Causative factor of chronic periodontitis is the plaque with its bacterial biofilm. The inflammatory process due to this biofilm results in destruction of the periodontal ligament and alveolar bone. The exact etiology of RA is unknown. It is believed ‘RA is triggered by exposure of an immnunogenetically susceptible host to an arthritogenic microbial antigen’ This sets up autoimmune reaction with local release of inflammatory mediators and lytic cytokines, resulting in destruction of the joint. Host derived inflammatory mediators such as cytokines, prostaglandins and matrix metalloproteinases - MMPs are believed to be responsible for the progression of CP and also in the pathogenesis of RA.

The highly pathogenic bacteria P. gingivalis is one of the key pathogen in periodontitis. P.gingivalis is believed to be the only known bacterium that could express the enzyme Peptidyl Arginine Deiminase (PAD). PAD enzyme through citrullination cause post-translational modification of structure of proteins. this results in generation of auto-immunity to these citrullinated peptides. In RA antibodies to citrullinated protein such as keratin, filagrin, fibrin, vimentin, fibrinogen as well as Anticyclic Citrullinated Protein Antibodies -(ACPA). Among these ACPA are regarded as highly specific for RA. Thus oral infection by P.infection could contribute to development of RA.

Significant reduction in Disease Activity Score (DAS 28) of rheumatoid arthritis, improvement in quality of life (QOL) and reduction of Probing pocket depth (PPD) of periodontium have been reported by few authors abroad, following non-surgical periodontal therapy. But such studies have not been reported in India till now, although few authors tried to analyze whether there is an association between RA and CP. This study focuses on the clinical parameters of both disorders- RA and CP following non-surgical periodontal therapy and analyse if there is a reduction in severity of both these diseases thereby correlating the severity of RA and CP with ACPA.