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Periodontal Health and Oral Microbiota in Patients with Rheumatoid Arthritis

Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, 14104 Huddinge, Sweden
Center for Rheumatology, Academic Specialist Center, Stockholm Health Services, 10235 Stockholm, Sweden
Department of Dental Medicine, Division of Orofacial Diagnostics and Surgery—Image and Functional Odontology, Karolinska Institutet, Huddinge 14104, Sweden
Science for Life Laboratory School of Biotechnology, KTH Royal Institute of Technology, 17121 Stockholm, Sweden
Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, 17164 Stockholm, Sweden
Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Solna, 17176 Stockholm, Sweden
Department of Periodontology, Faculty of Odontology, Malmö University, 20506 Malmö, Sweden
Department of Periodontology at Eastmaninstitutet, Stockholm County Council, 11382 Stockholm, Sweden
Authors to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(5), 630;
Received: 31 March 2019 / Revised: 23 April 2019 / Accepted: 1 May 2019 / Published: 8 May 2019
PDF [391 KB, uploaded 8 May 2019]


This study aimed to investigate the periodontal health of patients with established rheumatoid arthritis (RA) in relation to oral microbiota, systemic and oral inflammatory mediators, and RA disease activity. Forty patients underwent full-mouth dental/periodontal and rheumatological examination, including collection of blood, saliva, gingival crevicular fluid (GCF) and subgingival plaque. Composition of plaque and saliva microbiota were analysed using 16S rRNA sequencing and levels of inflammatory mediators by multiplex-immunoassay. The majority of the patients (75%) had moderate or severe periodontitis and the rest had no/mild periodontitis. Anti-citrullinated protein antibody (ACPA) positivity was significantly more frequent in the moderate/severe periodontitis (86%) compared to the no/mild group (50%). No significance between groups was observed for RA disease duration or activity, or type of medication. Levels of sCD30/TNFRSF8, IFN-α2, IL-19, IL-26, MMP-1, gp130/sIL-6Rß, and sTNF-R1 were significantly higher in serum or GCF, and April/TNFSF13 was significantly higher in serum and saliva samples in moderate/severe periodontitis. The microbial composition in plaque also differed significantly between the two groups. In conclusion, the majority of RA patients had moderate/severe periodontitis and that this severe form of the disease was significantly associated with ACPA positivity, an altered subgingival microbial profile, and increased levels of systemic and oral inflammatory mediators.
Keywords: rheumatoid arthritis; periodontitis; periodontal disease; anti-citrullinated protein autoantibodies; rheumatoid factor; smoking; medication; Porphyromonas gingivalis rheumatoid arthritis; periodontitis; periodontal disease; anti-citrullinated protein autoantibodies; rheumatoid factor; smoking; medication; Porphyromonas gingivalis
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Eriksson, K.; Fei, G.; Lundmark, A.; Benchimol, D.; Lee, L.; Hu, Y.O.O.; Kats, A.; Saevarsdottir, S.; Catrina, A.I.; Klinge, B.; Andersson, A.F.; Klareskog, L.; Lundberg, K.; Jansson, L.; Yucel-Lindberg, T. Periodontal Health and Oral Microbiota in Patients with Rheumatoid Arthritis. J. Clin. Med. 2019, 8, 630.

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