الفهرس 
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Abstract
Rheumatoid arthritis is a chronic inflammatory multisystem autoimmune disease affecting 1% of the adult population, most common in females, affecting women three times more than men and prevalence rises with age, with a peak in the fifth decade. It is characterized by persistent synovitis causing destruction of joint cartilage and bone, joint pain, and decreased mobility.
Diseases like RA result in the (patho) physiological citrullination of structure proteins and in an increased accumulation of citrullinated proteins. The reduced immunotolerance of these patients to citrullinated proteins seems to be a key problem, so that an increased formation of autoantibodies develops.
Periodontitis is defined as “an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with increased probing depth formation, recession, or both.”
Peridontal infection with Porphyromonas gingivalis could contribute to the total antigenic load of citrullinated proteins, generated by host peptidyl arginine deiminase (PAD) during the inflammatory response and by bacterial PAD produced as a virulence factor of P. gingivalis.
P. gingivalis, the sole microorganism documented to express PAD, an enzyme responsible for post-translational citrullination of arginine residues, would allow individuals with periodontitis to be exposed to citrullinated antigens, predisposing to development of anti-CCP antibodies, implicated in the pathogenesis of RA.
In this study we aimed to determine the prevalence of chronic periodontitis in a cohort of Egyptian RA patients, and their 1st degree relatives and siblings compared to control group, to determine the organisms causing periodontitis in RA patients, and to detect the presence of ACPA in gingival crevicular fluid (GCF) in those with periodontitis from the 3 studied groups (RA patients, their 1st degree relatives and siblings, and a control group), and its relation to serum ACPA in RA patients, and their 1st degree relatives and siblings.
This study was carried out on three groups: group I included 100 patients with Rheumatoid Arthritis fulfilling the 2010 ACR/EULAR classification criteria for RA and of less than 5 years disease duration, recruited from those attending the Rheumatology Unit and Rheumatology outpatient clinic at the Alexandria Main University Hospital. group II included 50 1st degree relatives and siblings of RA patients, who were free of clinical joint disease, and group III included 50 age and sex matched healthy subjects referred for general dental treatment at Dental clinic of the Alexandria Main University Hospital.
Smoking as a well recognized shared risk for rheumatoid arthritis and periodontal disease, together with diabetes mellitus, individu¬als who had undergone periodontal treatment (including prophy¬laxis) and/or antibiotic therapy over the past three months, faulty prosthesis and fillings, and females who are pregnant and lactating, all were excluded from the study.
All patients were subjected to: Detailed history taking, thorough systemic physical examination with stress on joint examination for RA group by assessing (tender joint count, swollen joint count, RA disease activity by applying DAS28 involving four parameters (ESR version), and functional state of the patients by applying HAQ score.
Dental examination done for all subjects in the 3 groups to detect and classify periodontal disease according to American Academy of Periodontology 1999 using: Probing Pocket Depth, Clinical Attachment Loss, Plaque Index, and Modified Gingival Index.
Laboratory investigations included: complete blood count, blood urea, serum creatinine, liver enzymes (ALT, AST), erythrocyte sedimentation rate, and C-reactive protein.
Rheumatoid factor titre by Rose Waaler test was done for group I and group II.
ACPA in serum was done for group I, group II, and group III with Periodontitis by ELISA.
ACPA in GCF for those with periodontitis from the 3 studied groups.
Conventional- polymerase chain reaction for 3 organisms: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in subjects with Periodontitis in the 3 studied groups.
X-ray of both hands for all subjects in RA group to detect erosions and severity of the disease.
The results of study showed that: periodontitis is more prevalent in RA patients than general population. RA patients with periodontitis have deeper pockets with more Clinical attachment loss and more plaque deposits than general population. RA disease activity tracks with PD severity. Periodontopathic organisms in RA patients with periodontitis weren’t unique. P.gingivalis is more prevalent in healthy controls than RA patients and their 1st degree relatives and siblings. P.gingivalis is not associated with more positive neither ACPA in (serum or gingival crevicular fluid) nor RF over other studied organisms. ACPA was detected in GCF samples from periodontitis cases being of higher levels in RA subjects.
1st degree relatives and siblings of RA subjects did not differ from healthy controls in periodontal disease severity, and mean ACPA levels in serum (generally and in periodontitis cases) and in GCF. The diversity of periodontopathic organisms in them was similar to RA patients.