A116: Increased Antibody Responses to Porphyromonas Gingivalis in Children With Anticyclic Citrullinated Peptide Antibody‐Positive Juvenile Idiopathic Arthritis
Authors: Lauren Lange, Geoffrey M. Thiele, Mina Pichavant, Gabriel Wang, Lori Ponder, Kelly Rouster Stevens, Sheila T. Angeles‐Han, Christine Kennedy, Larry B. Vogler, Ted R. Mikuls, Sampath Prahalad
Journal: Arthritis & Rheumatology (2014)

Background/Purpose: Rheumatoid arthritis (RA) is an inflammatory arthritis typically presenting in women in their fifth decade. Most individuals with RA have antibodies to citrullinated peptide antigens, such as anti‐cyclic citrullinated peptide antibodies (CCP). In addition to genetic factors, cigarette smoking and periodontal disease (PD) secondary to Porphyromonas gingivalis are risk factors for RA. Some children with juvenile idiopathic arthritis (JIA) phenotypically resemble adults with seropositive RA, characterized by the presence of anti‐CCP antibodies. Our objective was to investigate the association between anti‐CCP antibodies and anti‐ P . gingivalis antibodies, as well as the association between anti‐CCP antibodies and symptoms of PD, in children with CCP‐positive (CCP+) JIA vs. children with CCP‐negative (CCP−) JIA. Methods: Study participants included 77 children with CCP+JIA and 130 children with CCP‐JIA. Antibodies to P . gingivalis , P . intermedia , and F . nucleatum outer membrane antigen were measured using ELISA in 71 children with CCP+JIA and 74 children with CCP‐JIA. Oral health history and smoke exposure history were collected using a parent questionnaire from 37 children with CCP+JIA and 127 CCP‐JIA. T‐tests were used to compare means between the two groups; Chi‐Square or Fisher's tests were used to compare categorical variables. Results: Children with CCP+JIA were more likely to be female (89% vs. 64%), older at the time of diagnosis (10.3 vs. 6 years), and either African American (29.9% vs. 11%) or Hispanic (17% vs. 9.2%) compared to children with CCP‐JIA. Anti‐ P . gingivalis IgG antibody titers were significantly higher in the CCP+JIA cohort than in the CCP‐JIA cohort (9.04 vs. 5.69; p &lt; 0.003). Anti‐ P . intermedia IgG and anti‐ F . nucleatum IgG antibody titers were not different between the two groups. There was no association between CCP+JIA and smoke exposure in the prenatal period or in the 6 months prior to JIA symptom onset. Several symptoms of poor oral hygiene were higher among children with CCP+JIA: red/swollen gums (35% vs. 20%, p &lt; 0.08), tender bleeding gums (41% vs. 24%, p &lt; 0.06), pain on chewing (38% vs. 18%, p &lt; 0.03), and never/rarely flossing (49% vs. 32%, p &lt; 0.08). Of note, there was no significant difference in the frequency of cavities between children with CCP+JIA and children with CCP‐JIA. When oral health comparisons were limited to Non‐Hispanic white subjects, red/swollen gums (p &lt; 0.003) and tender bleeding gums (p &lt; 0.002) were even more prevalent in children with CCP+JIA compared to children with CCP‐JIA. Conclusion: We have shown that children with CCP+JIA have higher titers of antibodies to P . gingivalis compared to children with CCP‐JIA. Furthermore, children with CCP+JIA appear to have symptoms of poor oral health. There was no association between smoke exposure and CCP+JIA. To our knowledge, this is the first study to explore the relationship between these risk factors and the onset of CCP+JIA.