A Meeting of the Minds for RA Research

“We can use the anticitrullinated protein antibody profiles as a surrogate measure of protein citrullination that’s occurring in tissue, and thereby identify putative autoantigens,” he said.

This work has drawn early attention to the role of antibodies targeting citrullinated heat shock proteins, molecular chaperones that assist with the folding and unfolding of other proteins, contributing to important cellular metabolic processes.

The Link Between Periodontitis and RA

RA and periodontitis have many ties: shared risk factors, the fact that periodontitis is more prevalent in RA patients and vice versa, and the possibility that treatments for RA might help with the signs and symptoms of periodontitis.

But according to Ted Mikuls, MD, MSPH, professor of medicine at the University of Nebraska Medical Center in Omaha, it’s an under-researched area, with generally small and poorly controlled studies. He is embarking on the largest study to date on the diseases.

Mikuls is particularly interested in the role of Porphyromonas gingivalis (P. gingivalis), a major pathogen in periodontitis, that might play a role in autoantigen presentation and the development of anticitrullinated protein antibodies, which are associated with poor RA outcomes.

Dr. Mikuls’ study sets out to confirm in a larger and better-defined population the links between periodontitis and RA, and to demonstrate that those links are mainly due to infection with P. gingivalis.

He and colleagues will also try to determine whether antibodies to P. gingivalis are more common in people at a high risk for developing RA than in those at lower risk.

“The aim is somewhat ambitious, but I think we’re on track to do this,” Dr. Mikuls said, “to enroll 600 patients into the study with systematic physical examinations and several other detailed measures.”

REF President, E. William St.Clair, MD (left) and REF Scientific Advisory Council Chair, David R. Karp, MD, PhD.

Another Look at Periodontal Disease

Another study examining the role of periodontal disease in RA is under way, headed by Clifton Bingham III, MD, assistant professor of medicine at Johns Hopkins University. Dr. Bingham and his team are analyzing data from 200 RA patients who have gotten a comprehensive oral exam.

“One of the questions that I had was: What about early rheumatoid arthritis specifically, people at the beginning of their disease, what does periodontal disease look like in that cohort?” he said.

The researchers have split the study patients into early RA and more advanced RA groups. They’ve found that periodontal disease is common and significant in both groups. “We’re seeing very, very high numbers here in our entire population,” Dr. Bingham said. “The bottom line from this shows that certainly, in patients who have very early rheumatoid arthritis, both the prevalence and severity is the same as in patients with established disease.”