Periodontal Assessment in RA Study (PARAS)

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DESCRIPTION (provided by applicant): The pathogenic mechanisms of rheumatoid arthritis (RA) and periodontal disease (PD) are remarkably similar, with similar cellular events in the inflammatory focus, common profiles of cytokines, proteases, and inflammatory markers, and bone and collagen degradation. An increased prevalence of PD has been described in patients with longstanding RA, yet further exploration of this association has been limited. Many have argued that RA predisposed to the development of PD with hypothesized interactions of decreased salivary pool, poor oral hygiene from hand disability, or medication effects. The growing appreciation of Anti-CCP antibodies as diagnostic and prognostic markers for RA is significant, given that certain strains of bacteria associated with progressive periodontal disease represent a source of an enzyme producing citrullinated peptides, potentially serving to trigger the attendant antibody response seen in RA. Thus, it is possible that PD serves as a precipitant for some cases of RA or is a modifying factor of the disease. The recognition of an influence of PD on other systemic illnesses, notably diabetes and atherosclerotic disease, in which shared pathogenic mechanisms are less clear, provide additional rationale to evaluate relationships between PD and RA, diseases in which the mechanisms of disease have many similarities. It is our hypothesis that the prevalence of periodontal disease in RA patients at the onset of their arthritic disease is increased compared to matched controls without RA and that the presence and severity of PD will correlate with RA disease activity. Specific Aim 1 is to evaluate a cohort of subjects with newly diagnosed RA for periodontal health compared to control subjects without arthritis. The primary outcome measurement will be the presence of periodontal disease in RA compared to non-arthritic controls. Specific Aim 2 is to explore relationships between RA disease activity with periodontal severity. These studies represent the first comprehensive evaluation of periodontal disease in early RA and will provide important preliminary data and biological samples for further studies of disease progression, response to therapy, and to elucidate common mechanisms of pathogenesis. This study represents a collaborative effort between Rheumatology at Johns Hopkins, the Univ. Of Maryland College of Dental Surgery, and NYU College of Dentistry. The relationships developed for this study constitute a unique multi-centered interdisciplinary group of investigators and will facilitate the preparation and implementation of much broader research proposals to more clearly define the overall oral health of patients with RA.