Oral Anaerobic Bacteria in the Etiology of Ankylosing Spondylitis

Presence of periodontal disease and the incidence of inflammatory arthritides in the general population: data from the UK Biobank

OBJECTIVES

To investigate the association between periodontal disease and the development of inflammatory arthritides in the general population.

METHODS

In total, 489 125 participants from the UK Biobank without a previous history of RA, AS and PsA were enrolled. The primary outcome was the incidence of inflammatory arthritides, which was a composite of RA, AS and PsA according to the presence of periodontal disease based on self-reported oral health indicators. Multivariate Cox proportional hazard regression analyses using four different models were performed to assess the association between periodontal disease and inflammatory arthritides development.

RESULTS

In all, 86 905 and 402 220 individuals were categorized as with and without periodontal disease, respectively. Cox hazard analysis indicated that the presence of periodontal disease was an independent predictor of the occurrence of composite outcomes of inflammatory arthritides, which was also consistent for RA and AS. Significant associations were found to be consistent in the four Cox models and were replicated even when different criteria were used to define periodontal disease. Subgroup analyses indicated that periodontal disease was associated with an increased RA risk in those aged <60 years, and this risk was persistent for both male and female patients and for patients with seropositive/seronegative RA.

CONCLUSION

Self-reported periodontal disease is associated with inflammatory arthritides incidence in participants included in the UK Biobank, particularly for RA and AS. Higher clinical attention and optimal dental care in patients with signs of periodontal disease may be recommended for early disease detection and for reducing this risk.

Reactive Arthritis Resulting From Postoperative Complications of Third Molar Extraction: A Case Report

The role of bacterial infections as potential triggers for chronic rheumatic diseases is well-documented. Oral infections such as periodontitis may play a particularly important role in the development of autoimmune diseases, with the oral cavity serving as a reservoir for pathogenic bacteria. These bacteria may trigger dysregulatory immune responses through mechanisms like molecular mimicry, whereby bacterial peptides resemble self-peptides. Genetic factors may also predispose individuals to specific autoimmune diseases, most notably human leukocyte antigen B27 (HLA-B27) in the case of ankylosing spondylitis as well as other rheumatic diseases.

We present a case of a 23-year-old woman with reactive arthritis resulting from a postoperative infection. The patient presented with bilateral shoulder pain, decreased range of motion, worsening lower back pain, and mandibular pain at the site of a recent third molar extraction. Though initially diagnosed with rheumatoid arthritis, the patient experienced rapid and dramatic improvements following surgical treatment of the unresolved infection, demonstrating a causative or temporally related association between oral infections and chronic systemic autoimmune disease.

This case provides useful evidence regarding causal mechanisms for the connections between chronic autoimmune diseases and oral bacterial infection, illustrating how oral infection may serve as a causative factor for reactive arthritis. We suggest that this implicates bacteria normally present in oral microflora as a potential source of the antigens involved in triggering systemic inflammation, especially those already associated with other autoimmune diseases, such as Klebsiella pneumoniae in the case of ankylosing spondylitis. Based on prior publications linking self-peptides with homologies in such bacteria, we speculate on mechanisms underlying this connection, with particular attention to molecular mimicry. Clinicians should be aware of the close connection between certain rheumatic diseases (such as reactive arthritis) and bacterial infection, particularly of the oral cavity; such awareness should inform strategies for treatment and prevention of arthritic disease.

Periodontal diseases and its association with disease activity in ankylosing spondylitis/SpA: A systematic review

A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of the soft and hard connective tissue. There is evidence of increased levels of tumor necrosis factor-alpha and various interleukins in both patients of AS and periodontitis. This study aimed to conduct a systematic review exploring the relationship between AS and PD. We searched MEDLINE - Embase databases (from their inception till October 2019) using appropriate combinations of the following search items with limits '(English, Human)': Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, rheumatic disease and periodontitis, PD, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL). This search was supplemented by the manual search of bibliographies of the selected articles and conference proceedings of the European League against Rheumatism. Only the reviews and observational studies of cross-sectional, cohort, or case-control type on adult patients with AS were selected. Data were extracted from a predesigned PROforma. A total of 984 articles were identified, and 12 were selected for a detailed appraisal. All the identified studies were of the case-control type. The prevalence of periodontitis ranged from 38% to 88% in patients with AS and 26% to 71% in the control group. Of the 12 studies, 2 showed significant changes in PI, 2 showed altered PPD, 3 showed significantly increased CAL, and 2 showed increased BOP. In 7 studies, periodontitis was seen in a significant number of patients with AS (p<0.05). All the studies reported that the prevalence of PD in patients with AS was higher than that in patients without AS. Our systematic review found an association between AS and PD. Patients with AS show a higher prevalence of periodontitis and poor oral hygiene than the healthy controls.

Usefulness of complex bacteriological and serological analysis in patients with spondyloarthritis

Spondyloarthritis (SpA) is a group of associated chronic systemic inflammatory immune-mediated rheumatic diseases affecting axial and peripheral joints and entheses. The aim of the present study was to identify what parameters are useful to determine in order to better understand the correlation between the disease activity/severity and the microbiological results/immune status against intestinal and/or urogenital pathogens. Microorganisms known to trigger SpA, including Klebsiella spp., Yersinia spp., Salmonella spp., Campylobacter spp. and Chlamydia spp., were analyzed in various specimens (stool, urine, synovial fluid and serum) collected from 27 randomly selected SpA patients and 26 healthy controls using a combined direct and indirect approach relying on conventional culture technique and nucleic acid-based assays together with serological testing by ELISA. Although Escherichia coli derived from phylogroup A prevailed in the gut microflora of the patients and controls, differences were observed regarding the representatives of the other phylogroups with a higher prevalence of E.coli members of phylogenetic group B1 in the stool specimens of patients. Antibodies against the targeted species were detected in SpA patients and controls, and the serological profiles of the former were more diverse and complex. In conclusion, the detection of anti-bacterial antibodies combined with other specific laboratory investigations should be more extensively used to monitor SpA patients in association with their symptoms and in order to determine and administer more effective therapeutics.

Periodontal condition is associated with disease duration and motoric disabilities in patients with ankylosing spondylitis: results of a cross-sectional study

OBJECTIVE

Recent literature reveals worse periodontal health condition in ankylosing spondylitis (AS). However, roles of AS-related parameters, periodontal condition, and their association appear unclear. This cross-sectional study aimed at investigating dental and periodontal health as well as potentially periodontal pathogenic bacteria in patients with AS compared to healthy control subjects (HC).

METHODS

Dental examination comprised dental findings (DMF-T), periodontal probing depth (PPD), bleeding on probing, clinical attachment loss (CAL), papillary bleeding index, and microbiological analysis based on polymerase chain reaction of selected potentially periodontal pathogenic bacteria. Classification of periodontitis severity was based on PPD and/or CAL and divided into no/mild, moderate, and severe periodontitis.

RESULTS

52 participants with AS and 52 HC were included. 96% of the AS group and 75% of HC had moderate to severe periodontitis (moderate: AS = 26, HC = 34; severe: AS = 23, HC = 5; p < 0.01). Furthermore, a higher number of decayed teeth (D-T) were found in AS compared to HC (p = 0.02). A significant difference between AS und HC was detected for the prevalences of Parvimonas micra (AS = 92%, HC = 71%; p = 0.01), Eubacterium nodatum (AS = 35%, HC = 17%; p = 0.05), and Eikenella corrodens (AS = 96%, HC = 77%; p = 0.01). Bath Ankylosing Spondylitis Metrology Index (BASMI) and disease duration showed significant associations to PPD and CAL (p < 0.01).

CONCLUSION

Patients with AS show worse dental and periodontal conditions compared to HC. Thereby, prevalence of bacteria related to insufficient oral hygiene was higher in AS. BASMI and duration of AS affect periodontal burden. Accordingly, particular attention considering dental care and oral hygiene in AS patients seems to be reasonable.