Periodontal disease and the oral microbiota in new‐onset rheumatoid arthritis

Abstract

Objective To profile the subgingival oral microbiota abundance and diversity in never-treated, new-onset rheumatoid arthritis (NORA) patients. Methods Periodontal disease (PD) status, clinical activity and sociodemographic factors were determined in patients with NORA, chronic RA (CRA) and healthy subjects. Massively parallel pyrosequencing was used to compare the composition of subgingival microbiota and establish correlations between presence/abundance of bacteria and disease phenotypes. Anti-P. gingivalis antibodies were tested to assess prior exposure. Results The more advanced forms of periodontitis are already present at disease onset in NORA patients. The subgingival microbiota of NORA is distinct from controls. In most cases, however, these differences can be attributed to PD severity and are not inherent to RA. The presence and abundance of P. gingivalis is directly associated with PD severity as well, is not unique to RA, and does not correlate with anti-citrullinated peptide antibody (ACPA) titers. Overall exposure to P. gingivalis is similar in RA and controls, observed in 78.4% and 83.3%, respectively. Anaeroglobus geminatus correlated with ACPA/RF presence. Prevotella and Leptotrichia species are the only characteristic taxa in the NORA group irrespective of PD status. Conclusions NORA patients exhibit a high prevalence of PD at disease onset, despite their young age and paucity of smoking history. The subgingival microbiota of NORA patients is similar to CRA and healthy subjects of comparable PD severity. Although colonization with P. gingivalis correlates with PD severity, overall exposure is similar among groups. The role of A. geminatus and Prevotella/Leptotrichia species in this process merits further study.

Leptotrichia species in human infections II

“…Some species have been recovered from the human oral cavity, while others such as L. buccalis and L. goodfellowii have been recovered from dog bites [20] and guinea-pig wounds [6,21]. Based on 16S rDNAsequences comparisons Leptotrichia species were isolated from the hindgut of termites, fish, and even ocean sediments (Table 2) [3].…”

“…Since previous reviews [2,3], Leptotrichia species have been reported in >124 cases [4,7,16,18–69,87–93], whereby 30 cases involved L. buccalis [4,8,15,21,34,52,56,70–79,87], 24 cases L. wadei [4,20,24,34,37,42,48,56,67,80,81,90,93], 16 cases L. trevisanii [4,5,9,10,13,14,17,37,87], 14 cases L. hofstadii [34,40,49,56,81–84,93], 10 cases L. goodfellowii [4,11,12,21,56,74,85,87], eight cases L. hongkongensis [4,6,18,45,47,56], and five L. shahii [34,56,86]. L. trevisanii and L. wadei bacteremia are extremely rare; clinicians should consider these species in cases involving immunocompromised patients with oral lesions [4,5,13,17,87].…”

“…Saliva, plaque, and the oral mucosal surface of caries patients [34,37,56,67] and the oral cavity and biofilms from oral epithelial cells of a patient with new-onset rheumatoid arthritis [20,48] all contained L. wadei . Patient material from tongue plaque, saliva, and the tongue coating of malodor and halitosis patients [42,81] was isolated with L. wadei present.…”

“…Further, Leptotrichia species were recovered from healthy patients with oral cancer, premalignant oral lesion [18,28,33,56,91], edentulous infants [29], human vaginal fluid of sexually active and inactive individuals [30,32], HIV-seropositive and -seronegative patients [46], pancreatic cancer patients [18,66], black pigmented stain caries patients [63], and patients with halitosis (Table 2) [42,65,81,82]. Besides, Leptotrichia species were isolated from the blood [4,5,22,74], the amniotic fluid of a patient with a wound and respiratory difficulties [4], breast milk of obese women with gestational diabetes and normal weight [36], oral samples of a patient with new-onset rheumatoid arthritis [20], oral lichen planus patients [88], and even from fermenting Lees liquor [39]. Leptotrichia species were equally isolated from the blood and gastric fluid of patients with coronary artery disease (CAD), candidal esophagitis, chronic kidney disease, diabetic, duodenal ulcer, erythematous gastropathy, gastroesophageal reflux disease, gastric ulcer, hiatal hernia, reflux esophagitis, upper gastrointestinal bleeding, renal transplant, and sarcoidosis (Table 2) [16].…”

“…This indicated that L. buccalis can be more specifically associated with multiple disease activity than so far realized [20,52]. Irrespective of periodontal disease status, the Leptotrichia OTU 87 ( L. wadei ) clone and Prevotella OTU 60 ( P. intermedia ) clone were the only clones observed in increased amount in patients with new-onset rheumatoid arthritis but were absent in healthy controls [20]. …”