Effect of Inflammatory Arthritis on Periodontal Disease

Circulating cytokines are elicited by systemic inflammation and can appear in the oral cavity. The biologic functions of these cytokines may influence the health of the oral cavity in the gingiva or via saliva bathing the tissues. Objective: To determine if systemic inflammation contributes to clinical features of periodontal disease and levels of salivary biomarkers. Methods: A cross-sectional study enrolled 20 rheumatoid arthritis patients and 20 age/sex-matched controls. Arthritis was confirmed using American Rheumatology Association criteria. Subjects received a standardized medical examination and standard periodontal examination, and rated their level of overall pain on a visual analogue scale (VAS). Unstimulated whole saliva (UWS) was collected and analyzed for IL-1β, MMP-8, and TNFα and stimulated parotid saliva (PS) was collected and analyzed for RANKL using Luminex bead-multiplexed or ELISA procedures. Results: Arthritis subjects (mean: 46 yrs) had more periodontal sites with pocketing >5mm (p=0.06), sites with attachment loss >2mm (p=0.62) and significantly more sites with bleeding on probing (p=0.009) than the matched controls (mean: 46 yrs). No differences in gingival recession or number of teeth present were found between the groups. Mean UWS and PS levels of all analytes did not differ between the groups (p>0.26). The frequency of subjects having higher analyte levels (2 SD > mean) did not differ between groups. Only the UWS level of MMP-8 correlated with the level of pain rated on the VAS. Conclusion: These data suggest that arthritis patients may be at risk for periodontal inflammation, however this chronic systemic inflammation is not evident in select salivary inflammatory analytes. Therefore, salivary biomarkers of periodontal disease are not confounded by arthritis. This supports the potential utility of saliva as a diagnostic fluid for the assessment of periodontal health and disease in various patient groups. Supported by NIDCR grants U01 DE15017, DE017793 and M01 RR02602.