title: Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis.
abstract: BACKGROUND
  The association between rheumatoid arthritis (RA) and periodontitis is well established. Some children with juvenile idiopathic arthritis (JIA) phenotypically resemble adults with RA, characterized by the presence of anti-cyclic citrullinated peptide (CCP) antibodies. We sought to investigate an association between CCP-positive JIA and symptoms of periodontitis and antibodies to oral microbiota.
  
  
  METHODS
  Antibodies to oral pathogens Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum were measured using ELISA in 71 children with CCP-positive JIA and 74 children with CCP-negative JIA. Oral health history was collected from 37 children with CCP-positive JIA and 121 children with CCP-negative JIA. T-tests, Chi-square tests, Mann-Whitney U tests, and multivariable regression were used to compare the groups.
  
  
  RESULTS
  Compared to those with CCP-negative JIA, children with CCP-positive JIA were more likely to be female, older and non-Caucasian. Anti-P. gingivalis (p <0.003) and anti-P. intermedia (p <0.008) IgG antibody titers were higher in the CCP-positive cohort. Differences in P. gingivalis antibody titers remained significant after adjusting for age (p = 0.007). Children with CCP-positive JIA more likely reported tender/bleeding gums (43 % vs. 24 %, p < 0.02) compared to children with CCP-negative JIA. After controlling for age at collection, the odds of having tender/bleeding gums were 2.2 times higher in the CCP-positive group compared (95 % CI 0.98 - 4.83; p = 0.056).
  
  
  CONCLUSIONS
  Children with CCP-positive JIA have higher antibody titers to P. gingivalis and more symptoms of poor oral health, supporting a possible role for periodontitis in the etiology of CCP-positive JIA.
authors: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. llange@luriechildrens.org.
authors: Lauren
authors: L
authors: Lange
authors: VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA. gthiele@unmc.edu.
authors: Geoffrey M
authors: GM
authors: Thiele
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. Courtney.mccracken@emory.edu.
authors: Courtney
authors: C
authors: McCracken
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. gabriel.wang@emory.edu.
authors: Gabriel
authors: G
authors: Wang
authors: Children's Healthcare of Atlanta, Atlanta, GA, USA. lori.ponder@choa.org.
authors: Lori A
authors: LA
authors: Ponder
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. sangele@emory.edu.|Children's Healthcare of Atlanta, Atlanta, GA, USA. sangele@emory.edu.
authors: Sheila T
authors: ST
authors: Angeles-Han
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. kelly.a.rouster-stevens@emory.edu.|Children's Healthcare of Atlanta, Atlanta, GA, USA. kelly.a.rouster-stevens@emory.edu.
authors: Kelly A
authors: KA
authors: Rouster-Stevens
authors: University of Utah School of Medicine, Salt Lake City, UT, USA. aimee.hersh@hsc.utah.edu.
authors: Aimee O
authors: AO
authors: Hersh
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. lvogler@emory.edu.|Children's Healthcare of Atlanta, Atlanta, GA, USA. lvogler@emory.edu.
authors: Larry B
authors: LB
authors: Vogler
authors: University of Utah School of Medicine, Salt Lake City, UT, USA. john.bohnsack@hsc.utah.edu.
authors: John F
authors: JF
authors: Bohnsack
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. sabram5@emory.edu.|Children's Healthcare of Atlanta, Atlanta, GA, USA. sabram5@emory.edu.|Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA, USA. sabram5@emory.edu.
authors: Shelly
authors: S
authors: Abramowicz
authors: VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA. tmikuls@unmc.edu.
authors: Ted R
authors: TR
authors: Mikuls
authors: Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. sprahal@emory.edu.|Children's Healthcare of Atlanta, Atlanta, GA, USA. sprahal@emory.edu.|Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA. sprahal@emory.edu.
authors: Sampath
authors: S
authors: Prahalad
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000276:immunology*; D000917:Antibody Formation; D001171:Arthritis, Juvenile / Q000150:complications* / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology*; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D010518:Periodontitis / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D016966:Porphyromonas gingivalis / Q000276:immunology* / Q000302:isolation & purification
chemical_list: D000907:Antibodies, Bacterial; D001323:Autoantibodies