title: Periodontitis and Porphyromonas gingivalis in preclinical stage of arthritis patients.
abstract: OBJECTIVE
  To determine whether the presence of periodontitis (PD) and Porphyromonas gingivalis (Pg) in the subgingival biofilm associates with the development of rheumatoid arthritis (RA) in treatment naïve preclinical stage of arthritis patients.
  
  
  METHODS
  We conducted a prospective cohort study of 72 consecutive patients with arthralgia who had never been treated with any anti-rheumatic drugs or glucocorticoids. Periodontal status at baseline was assessed by dentists. PD was defined stringently by the maximal probing depth≧4 mm, or by the classification by the 5th European Workshop in Periodontology (EWP) in 2005 using attachment loss. Up to eight plaque samples were obtained from each patient and the presence of Pg was determined by Taqman PCR. The patients were followed up for 2 years and introduction rate of methotrexate (MTX) treatment on the diagnosis of RA was compared in patients with or without PD or Pg.
  
  
  RESULTS
  Patients with PD (probing depth≧4mm) had higher arthritis activity (p = 0.02) and higher risk for future introduction of MTX treatment on the diagnosis of RA during the follow up than patients without PD (Hazard ratio 2.68, p = 0.03). Arthritis activity and risk for MTX introduction increased with the severity of PD assessed by EWP, although not statistically significant. On the other hand, presence of Pg was not associated with arthritis activity (p = 0.72) or the risk for MTX introduction (p = 0.45).
  
  
  CONCLUSIONS
  In treatment naïve arthralgia patients, PD, but not the presence of Pg, associates with arthritis activity and future requirement of MTX treatment on the diagnosis of RA.
authors: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Motomu
authors: M
authors: Hashimoto
authors: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Toru
authors: T
authors: Yamazaki
authors: Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Masahide
authors: M
authors: Hamaguchi
authors: Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors: Takeshi
authors: T
authors: Morimoto
authors: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Masashi
authors: M
authors: Yamori
authors: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Keita
authors: K
authors: Asai
authors: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Yu
authors: Y
authors: Isobe
authors: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Moritoshi
authors: M
authors: Furu
authors: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hiromu
authors: H
authors: Ito
authors: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Takao
authors: T
authors: Fujii
authors: Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Chikashi
authors: C
authors: Terao
authors: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Masato
authors: M
authors: Mori
authors: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Takashi
authors: T
authors: Matsuo
authors: Center for Innovation in Immunoregulative Technology and Therapeutics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hiroyuki
authors: H
authors: Yoshitomi
authors: Department of Clinical Epidemiology and Biostatistics, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors: Keiichi
authors: K
authors: Yamamoto
authors: Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan.
authors: Wataru
authors: W
authors: Yamamoto
authors: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Kazuhisa
authors: K
authors: Bessho
authors: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Tsuneyo
authors: T
authors: Mimori
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018441:Biofilms / Q000254:growth & development; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D010518:Periodontitis / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D016966:Porphyromonas gingivalis / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate