Association Between Periodontitis and the Level of Anti-citrullinated Protein Antibodies in Rheumatoid Arthritis

Study Overview
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Brief Summary
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the relationship between rheumatoid arthritis and periodontal disease is crucial and has been explained via a complex interplay of genetic, environmental, and hormonal factors that influence the host immune tolerance leading to both disease characteristics. The aim of this study is to clinically investigate the correlation between the levels of anti-citrullinated protein antibodies (ACPAs) in gingival crevicular fluid before and after non-surgical periodontal treatment and the severity of periodontal disease and rheumatoid arthritis in rheumatoid arthritis (RA) patients

Detailed Description
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the relationship between rheumatoid arthritis and periodontal disease is crucial and has been explained via a complex interplay of genetic, environmental, and hormonal factors that influence the host immune tolerance leading to both disease characteristics. The aim of this study is to clinically investigate the correlation between the levels of anti-citrullinated protein antibodies (ACPAs) in gingival crevicular fluid before and after non-surgical periodontal treatment and the severity of periodontal disease and rheumatoid arthritis in rheumatoid arthritis (RA) patients Materials and Methods: a total of 40 participants suffering from periodontitis and rheumatoid arthritis will be referred from the Badr Hospital (Faculty of Medicine, Helwan University) to Misr international university's dental clinic complex. Gingival crevicular fluid (GCF) samples will be collected from the patients before performing periodontal therapy (baseline). Assessment of ACPAs will be quantified using enzyme-linked immunoassay (ELISA) as the primary outcome at baseline and after 3 months. Assessment of 2ry outcomes includes clinical periodontal and RA parameters at baseline and after 3 months.

Official Title
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Association Between Severity of Periodontitis and the Level of Anti-citrullinated Protein Antibodies (ACPAs) in Rheumatoid Arthritis Patients Before and After Non-surgical Periodontal Treatment (Pre and Post Study)

Conditions
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Periodontal Diseases, Rheumatoid Arthritis

Intervention / Treatment
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* Other: Non surgical periodontal treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Rheumatoid patients fulfilling the ACR criteria for the classification of RA 18 years Both genders Presence of at least 8 teeth Exclusion Criteria: Smoking Diabetes Mellitus Pregnant females Patients who had undergone periodontal treatment within last 3 months Antibiotic therapy during last 3 months Other autoimmune diseases

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: According to the periodontal parameters measured the cases will be categorized according to the latest classification of the 2017 World Workshop of classification of periodontal diseases and conditions as follows: staging of periodontitis is mainly based on the interdental CAL at the site of greatest loss and on radiographic bone loss and on tooth loss, over 4 stages-stage I, initial; stage II, moderate; stage III, severe; and stage IV, advanced periodontitis, Patient periodontal status will be assessed using William's graduated periodontal probe.Non-surgical periodontal treatment will be performed using ultrasonic scaler and subgingival curettes
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Non-surgical periodontal treatment<br>assessment of different periodontal parameters and gingival crevicular fluid sampling will be done then non surgical periodontal treatment will be performed then after 3 months re assessment of the periodontal parameters and gingival crevicular fluid sampling will be done | Other: Non surgical periodontal treatment<br>* Non-surgical periodontal treatment will be performed using ultrasonic scaler and subgingival curettes<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the level of anti-citrullinated protein antibodies (ACPAs) | assessment of the level of anti-citrullinated protein antibodies (ACPAs) in gingival crevicular fluid | at baseline and 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Clinical attachment Loss | measuring the distance from the cemento enamel junction to the base of the pocket in mm | at baseline and 3 months | 
| Change in Probing depth | measuring the distance from the gingival margin to the base of the pocket in mm | at baseline and 3 months | 
| Change in Plaque index (PI) | it is a score (0,1,2 and 3) where: 0 = No plaque in the gingival area. 1 = A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may only be recognized by running a probe across the tooth surface. 2 = Moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. 3 = Abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface | at baseline and 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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periodontitis, rheumatoid arthritis, anti citrullinated protein antibodies, peptidyl arginine deminase enzyme, gingival crevicular fluid (GCF)