Pos1599-hpr anti-ccp+ at-risk individuals have a mild phenotype of periodontal disease, which is treatable with a course of non-surgical periodontal therapy

Background Rheumatoid autoimmunity may be initiated at mucosal sites such as the periodontium. Patients with RA and anti-CCP+ at-risk individuals have an increased prevalence of periodontal disease (PD) [1] . PD is often asymptomatic and diagnosed by clinical examination. We hypothesised that comprehensive periodontal assessment of CCP+ at-risk individuals would identify PD, which would be amenable to treatment with a single course of non-surgical periodontal therapy (NSPT). Objectives To determine the periodontal disease phenotype in anti-CCP+ at-risk individuals and to investigate the feasibility/efficacy of a course of NSPT. Methods Anti-CCP+ at-risk individuals with musculoskeletal symptoms but no clinical synovitis (‘CCP+ at risk’) were recruited from the Leeds CCP cohort. All participants had a high anti-CCP level (>3 X ULN) and had periodontal screening by a dentist, including radiographs. Clinically significant PD was defined as clinical attachment loss ≥ 4mm on at least two non-adjacent teeth, ≥ 40mm of cumulative probing pocket depth (minimum 4mm per site). Those with PD were offered NSPT. Periodontal indices were recorded before and after NSPT. Treatment completion occurred when PD had stabilised, as determined by clinically significant reduction in bleeding/probing indices. Results Seventy-two CCP+ at-risk were offered screening; 51 (71.8%) accepted. The main reason cited for declining was time pressures. 31/51 (59%) subjects had clinically significant PD and were offered NSPT. Of these, 15 have completed treatment over a median of three treatment sessions (median timeframe 17 weeks). The remaining participants are receiving ongoing treatment. The mean age for patients with PD was 51.22 and 64.5% were female. Seven (22.6%) patients were current smokers, 16 (51.6%) ex-smokers and 8 (25.8%) never smokers. Mean baseline scores were; 49.41% plaque free, 15.14% bleeding, 21.46% mild pocketing, and 4.42% deep pocketing. Radiographic assessment revealed a predominantly mild (stage I/II) disease phenotype; 8 (25.8%) stage I, 11 (35.4%) stage II, 9 (29%) stage III, and 3 (9.7%) stage IV PD. Plaque free scores improved by 27.89% (p<0.05), demonstrating high patient motivation. Bleeding indices, (indicating gingival inflammation) reduced to 8.49%, within the accepted level for PD stabilisation [2] . There was significant probing depth reduction at both mild (10.02%) and deep (3.1%) sites (Table 1). Table 1. Demographic and clinical data of anti-CCP positive at-risk individuals who underwent periodontal assessment and treatment. Variable Participants with PD (n=31 ) Age (mean/SE) 51.22 (11.09) Females (n/%) 20 (64.5%) Baseline anti-CCP level (n/% ) >300u/ml 11 (35.5%) 100-300 9 (29%) 10-99 11 (35.5%) Baseline radiographic data (n/% ) Stage I 8 (25.8%) Stage II 11 (35.4%) Stage III 9 (29%) Stage IV 3 (9.7%) Treated patients (n=15 ) Before treatment After treatment P value Mean plaque free scores (%)* 51.23% (SE 21.88) 79.12% (SE 25.23) <0.05 Mean bleeding on probing (%)* 16.32% (SE 9.91) 8.49% (SE 4.13) <0.05 Mean mild (4-6mm) pocketing* (% ) 17.22% (SE 11.1) 7.2% (SE 4.33) <0.05 Mean deep (>6mm) pocketing* (% ) 3.7% (SE 1.1%) 0.69% (SE 1.7%) <0.05 Conclusion Routine periodontal assessment of anti-CCP+ at risk individuals identifies a mild and treatable phenotype of periodontal disease. Periodontal screening and treatment with a course of NSPT is acceptable to at-risk individuals and results in effective treatment of periodontal disease. This approach may form part of future personalised strategies for RA prevention. References [1]Mankia K, Cheng Z, Do T, et al. Prevalence of periodontal disease and periodontopathic bacteria in anti–cyclic citrullinated protein antibody–positive at-risk adults without arthritis. JAMA netw open. 2019 Jun 5;2(6):e195394-. [2]Deng K, Pelekos G, Jin L, et al. Gingival bleeding on brushing as a sentinel sign of gingival inflammation: A diagnostic accuracy trial for the discrimination of periodontal health and disease. J Clin Periodontol. 2021 Dec;48(12):1537-48. Acknowledgements: NIL. Disclosure of Interests Zhain Mustufvi: None declared, Rob Letton: None declared, Kate Harnden: None declared, Rahaymin Chowdhury: None declared, Aradhna Tugnait: None declared, Paul Emery Consultant of: Abbvie, Astra-Zeneca, BMS, Boehringer Ingelheim, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Samsung, Grant/research support from: Abbvie, BMS, Lilly, Novartis, Pfizer, Roche, Samsung, Sue Pavitt: None declared, Kulveer Mankia Consultant of: Lilly, UCB, Galapagos, Abbvie, Serac Healthcare, Grant/research support from: BMS, Lilly, Gilead.