Serum anti-CCP antibodies in periodontitis associated with rheumatoid arthritis - relative value for the severity of periodontitis
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Periodontitis, rheumatoid arthritis, ACPA, anti-CCP test

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Stefanov, L., Bolyarova-Konova, T., Kolarov, Z., Pavlova, P. and Ivanova, M. 2020. Serum anti-CCP antibodies in periodontitis associated with rheumatoid arthritis - relative value for the severity of periodontitis. Revmatologiia (Bulgaria). 28, 4 (Dec. 2020), 3-18. DOI:


Antibodies against cyclic citrullinated peptides (ACPA) have significant prognostic value for the onset or progression of rheumatoid arthritis (RA). Extraarticular citrullination and the production of ACPA as an immune response have been well documented in a number of tissues, including inflamed gingiva associated with periodontal disease. The aim of this study was to analyze the relative value of serum ACPA, determined by anti-CCP test, in the periodontitis (P) associated with RA severity`s assessment. The study included 60 patients with a mean age of 58 ± 10 (34 to 74 years), of whom 44 were women and 16 were men with concomitant P and RA. All patients underwent clinical and laboratory tests for the diagnosis of RA and clinical periodontal examination for the diagnosis of P, after signed informed consent. In the studied cohort we found that the average number of lost teeth was 8 ± 5 (0-18), and the average depth of periodontal pockets in mm was 4.4 ± 1.1. In 50% of patients there was a loss of attachment> 5 mm, and in 43% we found furcation lesions. Fifty-eight patients (96.7%) had a 100% prevalence of probing bleeding (BoP), and 47 patients (78.3%) had PISA ≥ 934.71mm². The mean value of PISA in the studied patients was 1727.04 ± 873.64 (214.37 - 4324.00). We did not find a statistically significant difference in serum ACPA levels depending on the severity of periodontal parameters PD (p = 0.357), CAL (p = 0.589) and PISA (p = 0.788). We found that the ROC-based cutoff values ​​for ACPA were high (123.85 IU / ml) and had low sensitivity and specificity in distinguishing between severe and moderate / mild forms of periodontal disease.
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