In fact, 20% of the prospective participants could not participate because they didn’t have 20 teeth left in their mouths.
The researchers are also looking at how bacterial and human peptidylarginine deiminase (PAD), the enzymes that citrullinates proteins, functions and is expressed in periodontal tissues, as well as how it is involved in generating autoantigens in patients with RA and periodontitis. They’ve found that citrullination and PADs are expressed both in periodontitis and normal cheek mucosa and tissue of the tonsil.
This team is also taking a close look at P. gingivalis, finding that it contains citrullinated proteins, and that RA patients make antibodies both to noncitrullinated and citrullinated versions of PAD-Pg.
So far, the work has further demonstrated the importance of the mouth in understanding RA, Dr. Bingham said. “One of the things that I’ve learned over doing this for the past five years or so is that the mouth does have a lot of information in it,” he said. “It’s frequently ignored, and I’m trying to teach fellows that you need to look in the mouth like you need to look at the feet.”
Comparison of RA Treatments
When an RA patient fails to respond to methotrexate and an anti–tumor necrosis factor (TNF) drug, rheumatologists are often left with a difficult decision: What do they do next?
Patients’ and physicians’ main choices are to try an intravenous TNF inhibitor; the monoclonal antibody rituximab; abatacept (Orencia), which works by inhibiting T cells; or tocilizumab (Actemra), which blocks interleukin-6 (IL-6).
However, Larry Moreland, MD, chief of the division of rheumatology at the University of Pittsburgh, said there’s no way to make an informed decision. “There’s really no data to suggest that one of these is better than the other,” he said. “No one’s compared these head to head, and no company’s ever going to do that.”
Dr. Moreland has received a planning grant from the ACR, and he and his team are proposing a comparative effectiveness trial. Planning is expected to take a year, and then they will have to seek further funding for the trial.
Because of the financial constraints of buying or getting donations of the drugs from the manufacturers for a traditional randomized trial, he is proposing that patients willing to participate have a drug chosen at random and then have their insurance pay for the drug.
Those making the assessments of the patients to see how they are responding to their drug would be blinded, although the patients would not be.
