Genetic correlation between rheumatoid arthritis and periodontal disease: the role of sex and IL-10.

The chronic stimulation of the immune system due to the presence of bacterial antigens within periodontal tissues has been associated with several autoimmune diseases, like diabetes mellitus, infective endocarditis or cardiovascular atherosclerosis. The current study aims at evaluating the correlation between Rheumatoid Arthritis (RA) and Periodontal Disease (PD) with special attention to genetic polymorphisms in cytokine expression. A total number of 34 patients affected by RA were recruited. Each of them underwent haematochemical analysis and data were collected for Rheumatoid Factor (RF), Anti-Citrullinated Protein’s Antibody (CCP) and HLA-BDR1. DAS-28 questionnaire for disease activity was fulfilled by the rheumatologist, while a periodontal examination was carried out by the dental clinician and crevicular fluid samples were collected to evaluate the IL-6, IL-10 and VDR polymorphysms. A connection between CCP and IL-10 polymorphisms was found, with IL-10 expressing protecting tendency against periodontal disease when CCP are found in the bloodstream (p=0.0017). Finally, males mainly expressed IL-10 predisposing genes (p=0.046), while females showed a greater tendency to express RF (p=0.014) and CCP (p=0.050). This paper corroborates the idea of a correlation between sex, IL-10 polymorphisms and RA, which should be studied in depth, since recent papers have shown that IL-10 injected into joints seems to decrease inflammation.

Periodontal microbioma and rheumatoid arthritis: The role of Porhyromonas gingivalis.

Rheumatoid Arthritis is a disease, which can be described as an autoimmune response after molecular mimicry caused by infective agents. The current study aims at evaluating the correlation between Rhematoid Arthritis (RA) and Periodontal Disease (PD), with special attention to the microbioma detected in the gums. Thirty-four patients with RD were recruited into the current study. Among rheumatic parameters, Rheumatoid Factor (RF), anti-citrullinated protein antibody (CCP), HLA-BDR1 and DAS28 were collected. A dental clinician evaluated the periodontal screening record (PSR). Afterwards, 1 paper cone was inserted for 30 seconds into the gingival sulcus then sent to the laboratory for evaluation. Quantitative PCR of 16S rRNA genes was performed with the hydrolysis probes method to identify and evaluate the amount Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum and Campylobacter rectus. There were no statistical differences in the composition of oral microbioma between PSR groups. There were no statistical significant differences between bacterial loads and serum values. On the contrary, a positive correlation was found between the presence of Porphyromonas gingivalis in periodontal pockets on one side and RF and CCP on the other. Therefore, the presence of Porhyromonas gingivalis in periodontal pockets is associated to RA inflammatory indices.

Three-dimensional morphological condylar and mandibular changes in a patient with juvenile idiopathic arthritis: interdisciplinary treatment.

Temporomandibular joint (TMJ) involvement is common but usually delayed in patients with juvenile idiopathic arthritis (JIA). We describe the case of a JIA patient with bilateral TMJ involvement, mandibular retrognathia, bone erosion, and severely restricted mouth opening. The use of cone beam computed tomography and a 3D diagnostic protocol in young patients with JIA provides reliable, accurate and precise quantitative data and images of the condylar structures and their dimensional relationships. Analgesics and conventional disease modifying antirheumatic drugs were ineffective, but interdisciplinary treatment with etanercept and a Herbst functional appliance improved functional TMJ movement and bone resorption.

How will I be when I will grow up? The importance of psychological intervention in pediatric patients to prevent symptoms from becoming chronical.

Psychological discomforts in pediatric patients, if not identified, and considered as personality traits can lead to abnormalities in the development. Identifying psychological problems and treating them with psychological intervention could avoid the raise of psychological disease in adulthood. The aim of this study is to evaluate the perception of self-image and interpersonal relationships of children affected by juvenile idiopathic arthritis (chronic pathology); to compare those data with those published in a previous research about enuretic children (functional pathology) and children affected by cleft palate (organic pathology). Forty children were tested using two Graphic Projective Tests: Machover test (Human Figure Drawing Test) and Corman test (Family Drawing Test) in order to assess specific disorders of their personality through the self-image perception and the emotional relationships with other members of family. Children affected by juvenile idiopathic arthritis show problems about the contact with the external world, underestimation of himself and inadequate perception of himself, exactly like children affected by enuresis and cleft lip and palate. Situation of discomfort, if not taken in consideration and seen as personality traits could easily become an emotional and behavioral chronic psychological disease.

[Temporomandibular joint involvement in juvenile idiopathic arthritis: treatment with an orthodontic appliance]. / Trattamento con un dispositivo ortodontico per l'impegno temporomandibolare nell'artrite idiopatica giovanile. Osservazioni su 72 casi.

OBJECTIVE: About 65% of children suffering from juvenile idiopathic arthritis (JIA) shows a more or less marked involvement of temporo-mandibular joint (TMJ) with altered mandibular growth, resorption of the condyles, occlusary instability, reduced chewing ability and facial dysmorphia. The purpose of our study is to prevent and to treat the progressive evolution of JIA on craniofacial growth and morphology with a functional appliance; surgery should be considered only in so far as the adequacy of TMJ movement is concerned. METHODS: From 1992 until now 72 children with proved JIA and TMJ involvement have been treated (50 females, 22 males, aged 6 to 16 years old). TMJ involvement was bilateral in 61% and unilateral in 39% of patients. A diagnostic workup was carried out involving tomograms of TMJ and cephalometric radiograph and analysis. The authors used a bimaxillary activator in the attempt to modify the unfavourable growth pattern and provide a gradual ante-rotation of the jaw. RESULTS: Almost all JIA patients showed satisfactory long term results, easing of pain, reduced skeletal discrepancy, increased function and good facial profile. CONCLUSIONS: The long term results of this study indicate that orthopaedic therapy might control the vicious circle of the malocclusion in children with JIA, preventing exacerbation of mandibular clockwise rotation. Surgical intervention for the improvement of TMJ function should be considered only if a severe restricted state is imminent.

Treatment of Raynaud's phenomenon with captopril.

The efficacy of captopril in the treatment of Raynaud's phenomenon was observed in an open study in 53 patients with primitive Raynaud's disease and in 18 patients with Raynaud's associated with scleroderma. Each patient was given captopril 25 mg three times a day for three months. The drug significantly decreased the frequency and the severity of ischaemic attacks in patients with Raynaud's disease, but did not affect the attacks in patients with scleroderma. These subjective ratings were supported by the results of digital strain gauge plethysmography during cold challenge. The therapy was discontinued in six patients (one because of an allergic skin reaction and five owing to orthostatic hypotension), but no serious side-effects were noticed.