Periodontal Assessment in RA Study (PARAS)

描述(申请人提供)：类风湿性关节炎(RA)和牙周病(PD)的致病机制非常相似，炎症灶中的细胞事件相似，细胞因子、蛋白酶和炎症标记物的共同特征，以及骨骼和胶原降解。在长期存在的类风湿性关节炎患者中，帕金森病的患病率有所增加，但对这种联系的进一步探索一直是有限的。许多人认为，类风湿性关节炎与唾液池减少、手残疾导致的口腔卫生不良或药物效应等假说相互作用，容易导致帕金森病的发生。抗CCP抗体作为RA的诊断和预后标志物越来越受到重视，因为与进行性牙周病相关的某些菌株代表着一种产生瓜氨酸多肽的酶的来源，这可能有助于触发RA中随之而来的抗体反应。因此，帕金森病可能是某些类风湿性关节炎的诱因，也可能是疾病的改变因素。对PD对其他系统性疾病的影响的认识，尤其是糖尿病和动脉粥样硬化性疾病，其共同的致病机制尚不清楚，为评估PD和RA之间的关系提供了额外的理论基础，这些疾病的发病机制有许多相似之处。 我们的假设是，与没有RA的对照组相比，RA患者在关节炎发病时牙周疾病的患病率增加，PD的存在和严重程度将与RA疾病活动相关。 具体目标1是评估一组新诊断的类风湿性关节炎患者的牙周健康状况 来控制没有关节炎的受试者。主要的结果测量将是牙周的存在。 类风湿性关节炎患者与非关节炎患者对照。 具体目的2是探讨类风湿性关节炎活动度与牙周严重程度之间的关系。这些研究代表了对早期RA牙周疾病的首次全面评估，并将为进一步研究疾病进展、治疗反应和阐明常见的发病机制提供重要的初步数据和生物样本。这项研究代表了约翰·霍普金斯大学风湿科之间的合作努力。马里兰牙科外科学院和纽约大学牙科学院。为这项研究建立的关系构成了一个独特的多中心跨学科研究小组，并将促进准备和实施更广泛的研究建议，以更清楚地定义类风湿关节炎患者的整体口腔健康。

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.