Periodontal Disease and P. Gingivalis in Rheumatoid Arthritis

Study Overview
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Brief Summary
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Periodontitis (PD) has been postulated to be a risk factor for the onset and progression of rheumatoid arthritis (RA). Recent reports suggest that infection with Porphyromonas gingivalis (P. gingivalis), a major oral pathogen in PD, could play a pivotal role in the development RA. The objective of this study is to examine the relationship of PD and P. gingivalis infection with the risk and severity of RA.

Detailed Description
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In this study, we will examine whether periodontitis (PD) and P. gingivalis impact rheumatoid arthritis (RA) risk by enrolling 300 patients with RA and 300 comparator patients with osteoarthritis and comparing results from comprehensive dental examinations and antibody responses to P. gingivalis. We will examine whether these associations are modified by the presence of certain genetic risk factors previously implicated in RA and whether evidence of infection with P. gingivalis precedes RA onset by examining banked sera from the Department of Defense Serum Repository (DoDSR) and the Studies of the Etiology of RA (SERA). We also plan to explore whether there are novel proteins expressed by P. gingivalis that drive autoimmunity in RA and whether immune responses to these bacterial proteins predict the future development of RA.

Official Title
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Periodontal Disease and P. Gingivalis in Rheumatoid Arthritis

Conditions
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Rheumatoid Arthritis, Osteoarthritis, Periodontal Disease

Intervention / Treatment
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* Radiation: Digital xray of jaw and teeth
* Procedure: Blood draw
* Other: questionnaires
* Procedure: Periodontal Examination
* Other: Bilateral digital xray of hands


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 19 years or older Diagnosis of rheumatoid arthritis, or osteoarthritis Have 9 or more evaluable posterior teeth (out of a total of 28 teeth, excluding third molars) Willing and able to provide informed consent Exclusion Criteria: Received tetracyclines within the last 6 months. Need for antibiotic premedication for dental probing. Pregnant or breast feeding

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Participants with Rheumatoid Arthritis<br>Rheumatoid arthritis patients Digital xray of jaw and teeth Blood draw questionnaires Periodontal Examination Bilateral digital xray of hands | Radiation: Digital xray of jaw and teeth<br>* one time xray of jaw and teeth<br>Procedure: Blood draw<br>* Three to four tablespoons of blood drawn.<br>Other: questionnaires<br>* completed questionnaires regarding patient's health and functional ability.<br>Procedure: Periodontal Examination<br>* Periodontal examination including measurement of gum pockets with a probe. Bacterial samples taken.<br>Other: Bilateral digital xray of hands<br>* One time digital xray of hands<br>|
| Osteoarthritis<br>Osteoarthritis patients Digital xray of jaw and teeth Blood draw questionnaires Periodontal Examination | Radiation: Digital xray of jaw and teeth<br>* one time xray of jaw and teeth<br>Procedure: Blood draw<br>* Three to four tablespoons of blood drawn.<br>Other: questionnaires<br>* completed questionnaires regarding patient's health and functional ability.<br>Procedure: Periodontal Examination<br>* Periodontal examination including measurement of gum pockets with a probe. Bacterial samples taken.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Show the associations of periodontitis with RA are primarily due to infection with P. gingivalis | Clinically defined PD will be more common in RA patients than in controls. 1.B.: Clinically defined PD will be associated with greater RA disease severity including autoantibody status and the presence and extent of radiographic disease progression. 1.C.: The associations of clinically defined PD with RA risk and severity will be explained by the presence of antibody to P. gingivalis. | within thirty days of enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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rheumatoid arthritis, osteoarthritis, periodontal disease