J.M. Bello-Gualtero

Periodontal Disease in Individuals With a Genetic Risk of Developing Arthritis and Early Rheumatoid Arthritis: A Cross-Sectional Study

BACKGROUND Recent consensus emphasizes the importance of studying individuals at risk for rheumatoid arthritis (pre-RA) and those with early RA (eRA). Periodontal tissues have been recently evaluated, but these studies are limited. To evaluate the periodontal condition, immunoglobulin (Ig)G subclasses against Porphyromonas gingivalis in individuals with pre-RA and eRA were compared with controls to establish an association between periodontal infection markers and rheumatic activity. METHODS Rheumatologic and periodontal condition was evaluated in 119 individuals with pre-RA, 48 patients with eRA, and matched controls. P. gingivalis IgG1 and IgG2 were analyzed. C-reactive protein, erythrocyte sedimentation rate (ESR), rheumatoid factor, anticitrullinated protein antibodies (ACPAs), and RA activity were measured. The groups were compared with McNemar test and paired t-test. Conditional logistic regression was performed for pre-RA confounders, and χ(2) test was used to evaluate periodontal variables and RA activity indices. RESULTS Pre-RA individuals showed significantly higher levels of plaque index (P = 0.01) and bleeding on probing (P = 0.03) and higher severity of periodontal disease (P = 0.02). Periodontitis was associated with pre-RA (odds ratio, 3.39; 95% confidence interval, 1.64 to 7.01) but not with eRA. In pre-RA, P. gingivalis-specific IgG2 was associated with ACPAs (P = 0.049) and disease severity visual analog scale (P = 0.03). In eRA, IgG2 against P. gingivalis was associated with ESR (P = 0.046) and ACPAs (P = 0.04). P. gingivalis was associated with ACPAs (P = 0.04). CONCLUSIONS This study shows that individuals with pre-RA have significant inflammatory periodontal involvement. There was a significant association between IgG against P. gingivalis and ACPAs in pre-RA and markers of RA activity in individuals with eRA.

Higher Levels of Secretory IgA Are Associated with Low Disease Activity Index in Patients with Reactive Arthritis and Undifferentiated Spondyloarthritis

Introduction Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. Objective To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. Methods This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. Results In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Conclusion Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.

Lower levels of vitamin D are associated with disease activity and low complement in Colombian patients with Systemic Lupus Erythematosus

BACKGROUND Systemic Lupus Erythematosus (SLE) involves genetic, environmental, and hormonal alterations, including Vitamin D deficiency. OBJECTIVE To evaluate the association between vitamin D levels with anti-dsDNA, complement proteins, immunoglobulins levels and disease activity scores. METHODS A cross-sectional study was performed. The levels of 25-OH vitamin D were measured in patients older than 18 years with SLE according to ACR/97 [American College of Rheumatology 1997] from 2013 to 2015. The association was assessed by Mann-Whitney U and Kruskal Wallis tests for continuous variables, and by the Chi or Fisher exact test for the nominal variables. RESULTS Sixty-nine patients were included; 82% were women; the mean age was 38.5 years; 36.2% had low levels of vitamin D with higher consumption [p=0.006] of C4 and C3 complement proteins, plus higher levels of anti-dsDNA. Lower values of vitamin D were observed in patients with moderate to severe activity [p=0.0001] by SLEDAI [Systemic Lupus Erythematosus Activity Index] and general domain [p=0.039] and renal domain [p=0.009] by BILAG [British Isles Lupus Assessment Group] 2004. The mean vitamin D levels were higher in the group not receiving steroids when compared to those groups with dosages of 0.5-1mg/kg/d [p=0.048]. CONCLUSION Lower levels of vitamin D are associated with greater complement protein consumption and higher disease activity rates. Therefore, it is important to evaluate vitamin D supplementation in patients with SLE as part of the treatment, especially when it includes the use of steroids.

OP0171 Leptin levels, overweight and p gingivalis presence contribute to the mechanism of systemic inflammation in first-degree relatives of rheumatoid arthritis individuals

Background Association studies in rheumatoid arthritis (RA) have been focused in the pre-clinical phases of the disease in first-degree relatives (FDR). Data has shown that obesity, ACPA and the periodontal condition may modulate the severity and the clinical presentation of RA Objectives To investigate the levels of adipokines in FDR and establish their association with the state of rheumatic and periodontal condition Methods 124 FDR individuals and 124 healthy controls matched by age and gender were included. Rheumatologic (clinical and serological markers) and periodontal assessment was performed. It was quantified the adiponectin, leptin, IL6 levels. HLA-DRB1 was determined. Serum markers of RA (rheumatoid factor, erythrocyte sedimentation rate, C reactive protein (CRP), and APCA. P gingivalis and IgG1/IgG2 P gingivalis were measured. Radiographs of hands and feet were evaluated the Sharp-van der Heijde score. An association analysis was made to evaluate the relationship between adipokines and periodontal, rheumatologic conditions using X2 test, and logistic regression model was performed to confirm this associations Results In FDR group, 71.77% were women with a mean age of 39.24±12.22 years. 37.09% had overweight and 4.83% had obesity. Among the controls, 70.97% were women, with an average age of 39.31±12.30 years. 27.41% had overweight and 4.83% had obesity. Leptin levels were found in 37.66% vs 18.42% in controls(p=0.002). In FDR, 60.48% had periodontal disease of which 62.66% moderate, P gingivalis in 62.10%. In controls, 55.64% had periodontal disease, of which 63.76% moderate with 42.74% P gingivalis positive (p=0.002). In the FDR, radiography of hands and feet showed in 25.28% of them had some alteration, 68.18% had ≥1 erosion, 45.45% had ≥1 joint space narrowing and in 6.89% juxtaarticular osteopenia. An association of leptin levels with the low economic level was found p=0.006 and high levels of leptin in individuals with BMI ≥30 p=0.031. IL6 was found to be associated with severity of periodontal disease, with higher levels being found frequently in mild periodontal disease p=0.039.The condition of FDR was significantly associated with high leptin levels adjusted for presence of swollen joints, presence of P gingivalis and low levels of IL6 OR=2,57, 95% CI: 1.14 to 5.95. In this group, the individual with leptin at moderate levels adjusted with BMI >25, has a lower probability of presenting CRP >3 mg/L OR=0.43 95% CI: 0.20 to 0.90. Conclusions High levels of leptin, the presence of P gingivalis and swollen joints may be relevant conditions associated with the development of RA in FDR.Leptin levels and overweight can modulate the production of acute phase proteins in this group of individuals contributing to the mechanism of systemic inflammation. The clinical implications of our findings propose regulated exercise programs, oral hygiene, and weight control in FDR Reference [1] Unriza-Puin S, et al. Clin Rheumatol2017;28(36):799–806. Disclosure of Interest None declared

AB0201 Influence of siga on clinical activity markers in spa patients with non-radiographic and peripheral compromise

Background There are previous evidence about inflammatory signs related with the intestinal mucosa in spondyloarthritis patients with seronegative arthritis and them relation with articular inflammatory activity. It is uncertain the role of these serological markers on the inflammatory/clinical activity in patients with SpA Objectives To establish the relationship among activity variables and indices, and soluble markers associated to mucosal associated lymphoid tissue in a group of SpA patients. Methods Patients were selected by rheumatologists with the ESSG criteria. Levels of SIgA, IgA, IgA Chlamydia trachomatis, Shigella spp, Yersinia ssp, Campilobacter ssp and Salmonella ssp, CRP,ESR,HLA-B27,BASDAI,ASDAS-CRP and ASDAS-ESR were determined. A principal components analysis (PCA), Poisson Regression and multiple correspondence analysis were performed to find relationships between clinical and laboratory variables and SIgA. This study was approved for Ethics Committee. Results 46 patients were included (78.2% males with a mean age 34.8±12.3 years). It was reported at least one gastrointestinal sing in 69.2% of patients:abdominal bloating (45%), abdominal pain (43%); all patients showed at least one musculoskeletal symptom, 69.5% enthesitis, 63% inflammatory back pain and 58.6% arthritis, as well as 43.4% previous infection and 47.8% presented HLA-B27.The PCA showed three principal factors which cover a contribution of 82.2% to explain the SIgA variation.The ASDAS-CRP, ASDAS-ESR, BASDAI variables which provide the 47.12%;the regression model shows an inverse association among SIgA and BASDAI (prevalence ratio (PR):0.43, 95% CI:0.26–0.70 p=0.001), ASDAS-CRP (PR:0.72, 95% CI:0.24–0.95 p=0.021) and ASDAS-ESR (PR:0.69, 95% CI:0.39–0.95 p=0.007); however, a risk was demonstrated among BASDAI and Yersinia IgA (PR:1.68 95% CI:1.03–2.74 p=0.036) and between ASDAS-CRP with HLA-B27 (PR:1.62 95% CI:1.18–2.19 p=0.0002). There was a relationship between the absence of clinical activity (ASDAS-CRP, ASDAS-ESR and BASDAI), previous infection, Yersinia IgA with SIgA Q1 (27.8–43.0 ug/mL); the presence of arthritis, Salmonella IgA, and high levels of CRP and ESR were related with SIgA Q2; SIgA levels among (Q3)12.2–18.0 ug/mL were associated with inflammatory back pain, obesity and Salmonella IgA <1/1600. High scores of BASDAI and ASDAS-CRP, absence of previous infection had a strong relation with low levels of SIgA. Conclusions SIgA serum level were the only one serologic maker, which had an inverse correlation with all clinical activity variables of disease, previous infection and some specific antibodies associated with intestinal mucosal infection, suggesting a protective role of this molecular shape of IgA that is characteristic of mucosal immune responses References Mantis NJ. Mucosal Immunol (2011) 4:603–11. Disclosure of Interest None declared

THU0137 Impact of periodontal and rheumatic disease markers on first-degree relatives of patients with rheumatoid arthritis according to age group

Background Rheumatoid arthritis (RA) and periodontal disease (PD) have similar underlying pathologic processes and share a general deregulation of the inflammatory response. Objectives To evaluate PD markers in first-degree relatives (FDR) of consanguinity individuals of patients with rheumatoid arthritis to compared with controls and to establish an association to rheumatic activity according to age groups Methods 201 FDR individuals and 201 matched controls were included. Clinical evaluation of rheumatologic and periodontal condition was performed. P. gingivalis, P. gingivalis IgG1 and IgG2, ESR, CRP, RF, ACPAs, painful and swollen joints were assessed. A frequencies analysis, comparisons and a logistic regression model were made. The study was approved by local ethics committee. Results 37.3% of patients with overweight and 10.1% obsesses. Subjects with more than one swelling joint were 21 subjects <30 years, 5 between 31–40, 5 between 41 to 50 subjects and 9 subjects over 50, for more one painful joint were 73. The RF was present in 8.0%, APCA in 13%, RA33 in 1%. 67.3% had a diagnosis of PD, 81.6% had a moderate-severe p=0.003.P. gingivalis was in 47,9%, and P. gingivalis IgG1 were in 54.7%. It was evidenced that 25.3% patients presented BMI>30, where 81.8% had periodontitis p=0.006. Regression analysis on the whole group shows a risk to present BMI>25 (OR 1.67 IC-95% 1.02 – 2.74 p=0.042), ACPAs (OR 3.7 IC-95% 1.34–10.22 p=0.012), at least one pain join (OR2.51 IC-95% 1.42–4.44 p=0.001) and gingival index (OR4.57 IC-95% 1.76–11.80 p=0.002) in FDR individuals. Based on age the risk to develop PD was increasing: individuals among 30 to 40 years shows OR 2.76 (IC-95% 1.24–6.18, p=0.013); among 41 to 50 years, OR 4.72 (IC-95% 1.81–12.32, p=0.001); and for >50 years individuals an OR 6.22 (IC-95% 2.55–15.1, p=0.0001). The discriminating analysis by age rank shows that FDR individuals <30 years (n=67) exhibited high risk to have at least one pain join (OR 3.84 IC-95% 1.28–11.47 p=0.016). In subjects among 30 to 40 years (n=46), the risk was associated with periodontal pocket (OR1.44 IC-95% 1.05–4.98 p=0.021), one or more pain join (OR 3.56 IC-95% 1.22–10.40 p=0.020) which it was maintained until 50 years individuals (n=35) (OR4.32 IC-95% 1.11–16.78 p=0.0034), individuals >50 years (n=53) show high risk to present BMI>25 (OR 4.00 IC-95% 1.46–10.45 p=0.007). Conclusions Obesity, ACPA and periodontitis can be considered as relevant conditions associated with the development of RA in FDRs. However, the analysis based on age group shows that periodontal markers do not appear early in FDR individuals; however, clinical rheumatologic variables are manifested and maintained over time. References Bello-Gualtero JM et al. J Periodontol 2016;87:346–356. Disclosure of Interest None declared

AB0675 Is The Periodontal Clinical and Microbiological Condition in Spondyloarthritis Similar than Rheumatoid Arthritis

Background The periodontal disease (PD) generates systemic impact given the increase in acute phase reactants related to the inflammatory. The relationship between Rheumatoid arthritis (RA) and PD is supported by pathological and immunological data but is not clear this association in Spondyloarthitis (SpA). The association between their respective disease activities and severities are less documented. Periodontal inflammation may affect disease activity and severity on patients with SpA. Objectives To evaluate the association between clinical indices of PD and markers of disease activity in SpA patients and compare these markers in patients with RA and controls. Methods The rheumatologic condition and periodontal status of 79 individuals with SpA, 59 patients with RA and 79 matched-controls were evaluated. Porphyromona gingivalis (Pg), IgG1, and IgG2 to Pg were determined. The C-reactive protein-, erythrocyte sedimentation rate-, HLA B 27, rheumatoid factor-RF, anti-citrullinated protein antibodies, and disease activity measures for SpA and RA were assessed. The rheumatologic Scores and periodontal condition were evaluated by two experienced and calibrated periodontists and rheumatologist. The groups were compared with Kruskal Wallis, Mann-Whitney U and Wilcoxon tests test and a paired t-test. The chi-square test was used to evaluate periodontal variables and SpA disease activity. The institutional Ethics Committee approved the study. Results 79 SpA patients with the following subtypes were included: Ankylosing Spondylitis (AS) (19), undifferentiated SpA (46), and reactive arthritis (ReA) (14). SpA patients had a considerable frequency of periodontitis (55.7%). Of them, 39.2% were classified as moderate and 2.5% as severe periodontal condition. No differences was found in frequency of periodontal condition between subtypes. SpA patients showed lower levels of insertion loss compared to RA patients and the control group (p<0.05). A significant association was observed in microbiological variables of SpA patients. The frequency of (P gingivalis) in the control group was 51.9% compared to 30% in SpA (p=0.015), especially in those with good response to NSAIDS (p= <0.05). Significant associations between the severity of periodontal involvement in RA patients was observed. 63.8% of RA patients had moderate severity disease (49.2%) and severe periodontitis (13.6%) (p=0.035) but not in SpA group. There were not association between disease activity measures in SpA, periodontal and severity condition. Conclusions As compared to RA and healthy controls, periodontal condition in SpA patients was similar. Lower grades of severity and bacterial load were found. This suggests that an interdisciplinary treatment between periodontists and rheumatologists may help to modulate periodontal condition and prevent systemic impact References Pischon N, Pischon T, Gülmez E, Kröger J, Purucker P, Kleber BM. Periodontal Diseases in Patients with ankylosing spondylitis. Ann Rheum Dis 2010;69:34–38. Białowąs K1, Swierkot J1, Radwan-Oczko M.Role of Porphyromonas gingivalis in rheumatoid arthritis and inflammatory spondyloarthropathies. Postepy Hig Med Dosw. 2014;68:1171–9. Disclosure of Interest None declared

AB0942 Diagnostic Value of Anti-RA33 Antibody in Comparison with Anti-Cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor in Patients with Early Arthritis and Individuals with First-Degree Relatives of Patients with RA

Background Rheumatoid Arthritis (RA) is an inflammatory autoimmune disease characterized by joint involvement, pain and inflammation with or without extra-articular joint commitment. Serological markers can guide early diagnosis before that clinical activity takes place, optimizing early diagnosis, less activity and functional disability. RA 33 is considered a diagnosis-marker in RA patients related to prognosis and therapeutic response compared with conventional markers. RA 33 is common in patients with negative conventional markers and with few clinical symptoms. Objectives Evaluated the frecuency of RA33 in individuals with first-degree relatives of patients with RA and patients diagnosed with early rheumatoid arthritis as a good prognosis marker Methods A transversal study was conducted evaluated rheumatologic and periodontal condition of 112 individuals with first-degree relatives of patients with RA and 46 patients diagnosed with early rheumatoid arthritis, according to classification criteria for RA (ACR-EULAR 2010). In addition, 47 healthy individuals were included. RA patients and control group were matched for age and gender. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor RF, ACPAs, and RA 33 were performed. VAS Pain Scale, SDAI Index, HAQ and DAS28 were evaluated. Porphyromona gingivalis (Pg) by CRP, IgG1, and IgG2 were determined. The data included in the study were analyzed using STATA 11.1. Associations were determined by the statistical test Chi 2, and Comparisons between groups of rheumatologic diagnosis and median values for continuous variables was performed using Mann-Whitney Test. Approved by the Ethics Committee of the Institution. Results 112 healthy individuals with first-degree relatives of patients with RA were assessed. Of them 78.3% has periodontal disease, presence of painful joints (30.63%). 36.94% patients had Pg in subgingival plaque samples. In the control group the presence of periodontal disease was 71.74%, tender joints (19.57%), swollen joints (6.52%). Disease activity measures were not representative. Only a woman in the group of family related RA patients was positive for RA 33 (49 years old, without treatment, painful and swollen joints and the presence of periodontal disease and Pg, ESR and CRP positives but RF and ACPAs negative). No patient with RA of less than two years of diagnosis was positive for RA 33. Conclusions The diagnostic value of anti RA33 was low in this population, with regard of worst prognosis markers and higher disease severity. Ra33 should be more follow-up clinical and paraclinical to subjects with risk factors who could have positive markers, without symptoms. References Fritsch R, Eselböck D.Characterization of Autoreactive T Cells to the Autoantigens Heterogeneous Nuclear Ribonucleoprotein A2 (RA33) and Filaggrin in Patients with Rheumatoid Arthritis. The Journal of Immunology.2002; 169 (2):1068–1076. Massardo L.Artritis reumatoide temprana early rheumatoid arthritis.Rev méd Chile. 2008; 136: 1468–1475 Disclosure of Interest None declared

SAT0134 Periodontal Condition as A Early Manifestation of Undiferenciated Arthritis

Background Periodontal disease (PD) and rheumatoid arthritis (RA) are two common chronic inflammatory diseases globally destructive. Recently, there has been increasing evidence that periodontal disease and rheumatoid arthritis share many biological and pathological features like the significant increase in acute phase reactants. It is important to demonstrate that periodontal inflammation can affect clinical index and variability of the patients with RA. Objectives To evaluate the association between clinical indices of PD and markers of activity in Colombian RA patients and individuals with first-degree relatives of patients with RA. Methods The rheumatologic condition and periodontal status of 73 individuals with rheumatoid early arthritis and 164 individuals first degree relative with RA patient were evaluated. Porphyromona gingivalis (Pg), IgG1, and IgG2 to Pg were determined. The C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor-RF, anti-citrullinated protein antibodies, RA 33 antibodies and scales of RA activity were measured. The rheumatologic Scores and periodontal condition were evaluated by two experienced and calibrated periodontists and rheumatologist. The chi-square test was used to evaluate association between periodontal variables and RA activity indices. The study was approved by the Ethics Committee of the Universidad El Bosque and the Hospital Militar Central, Bogotá, Colombia. Results RA group showed 67.1% of periodontitis, of which 43.8% were classified as moderate and 15.1% as severe, positive RF in 49 patients (67.2%) and ACPAs (52%), RA patients had association between dental Plaque >30% with activity clinical index DAS28ESR (p=0.05), SDAI (p=0.008), Bleeding of probing with DAS28ESR (p=0.05), ESR (p=0.03) and CRP (p=0.03) and association between clinical attachment level with ACPAs (p=0.05), Furthermore first-degree relatives of patients with RA showed periodontal disease in a 70.1% classified as moderate 43.9% and 12.8% as severe, positive RF 18 (18%), and ACPAs (7.1%), was finding association between gingival index with activity clinical index DAS28ESR (p=0.05), CRP (p=0.03), ESR (p=0.005) and RAPID3 (p=0.05), association periodontal pocket deep with HAQ-DI score (p=0.05) and bleeding of probing with SDAI (p=0.05). Conclusions RA and PD share pathophysiological mechanisms that explain how greater commitment periodontal dental plaque index and periodontal pocket deep are directly related to indices of clinical activity of the joint disease. This would explain the persistence of elevated acute phase reactants with minimal or absent joint clinical manifestations. References Bello-Gualtero JM, et al. Periodontal Disease in Individuals With a Genetic Risk of Developing Arthritis or With Early Rheumatoid Arthritis: A Cross-Sectional Study.J Periodontol. 2015;26:1–18 Disclosure of Interest None declared