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Rheumatoid Arthritis

  • Matthew L. Stoll
  • S. Louis BridgesJr.
  • Maria I. Danila
Chapter

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with both environmental and genetic factors but of unknown cause. There are >100 associated gene loci, the most significant of which is HLA-DRB1 in the major histocompatibility complex region. Recent work has also highlighted important roles of the human mucosal microbiota, at both the gingival as well as the intestinal surfaces. Periodontal disease and alterations in the gingival microbiota, including overgrowth of Porphyromonas gingivalis, are associated with RA. A key hallmark of RA is serum anti-citrullinated protein antibodies reactive against a variety of posttranslationally citrullinated proteins, which are enriched in RA, particularly in patients with HLA-DRB1 risk alleles. Citrullination of arginine residues is catalyzed by peptidylarginine deiminases (PADs). Of note, P. gingivalis produces its own PAD enzyme (PPAD), which may contribute to the citrullination of native proteins. Differences in the intestinal microbiota, particularly overgrowth of Prevotella copri, are associated with early RA, perhaps compensating for the absence of HLA-DRB1 risk alleles in some patients. As the role of the microbiota in RA is elucidated, targeted interventions to manipulate the microbiome to prevent or treat RA may emerge.

Keywords

Antibiotics Microbiota Periodontitis Probiotics Rheumatoid arthritis 

Abbreviations

ACPA

Anti-cyclic citrullinated peptide antibody

CRA

Chronic rheumatoid arthritis

DAS

Disease activity score

DC

Dendritic cells

HC

Healthy control

IL

Interleukin

JIA

Juvenile idiopathic arthritis

MMP

Matrix metalloproteinase

NORA

New-onset rheumatoid arthritis

NSAID

Nonsteroidal anti-inflammatory drug

OA

Osteoarthritis

PAD

Peptidylarginine deiminase

PD

Periodontal disease

PPAD

P. gingivalis peptidylarginine deiminase

RA

Rheumatoid arthritis

SE

Shared epitope

SRP

Scaling and root planning

TNFi

Tumor necrosis factor inhibitor

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Matthew L. Stoll
    • 1
  • S. Louis BridgesJr.
    • 2
  • Maria I. Danila
    • 3
  1. 1.University of Alabama at Birmingham, Department of PediatricsBirminghamUSA
  2. 2.Division of Clinical Immunology and Rheumatology, Comprehensive Arthritis, Musculoskeletal, Bone, and Autoimmunity Center, UABThe University of Alabama at BirminghamBirminghamUSA
  3. 3.University of Alabama at Birmingham, Division of Clinical Immunology and RheumatologyBirminghamUSA

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