Oral status in patients with early rheumatoid arthritis: a prospective, case-control study Original paper
Researched by:
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Kimberly Eyer
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Kimberly Eyer
Kimberly Eyer, a Registered Nurse with 30 years of nursing experience across diverse settings, including Home Health, ICU, Operating Room Nursing, and Research. Her roles have encompassed Operating Room Nurse, RN First Assistant, and Acting Director of a Same Day Surgery Center. Her specialty areas include Adult Cardiac Surgery, Congenital Cardiac Surgery, Vascular Surgery, and Neurosurgery.
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Rheumatoid Arthritis
Rheumatoid Arthritis
OverviewRheumatoid arthritis (RA) is a systemic autoimmune disease marked by chronic joint inflammation, synovitis, and bone erosion, driven by Treg/Th17 imbalance, excessive IL-17, TNF-α, and IL-1 production, and macrophage activation. Emerging evidence links microbial dysbiosis and heavy metal exposure to RA, [1][2] with gut microbiota influencing autoimmune activation via Toll-like receptor (TLR) signaling, inflammasome activation, […]
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Kimberly Eyer
Researched by:
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Kimberly Eyer
ID
Kimberly Eyer
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Kimberly Eyer
What was studied?
This prospective case–control study investigated oral microbiota in early rheumatoid arthritis (ERA) and its association with periodontal disease. The central aim was to determine whether a clinically meaningful loss of alveolar bone, as measured by clinical attachment level (CAL), could be detected in patients with ERA compared to healthy controls. A secondary objective was to assess whether distinct sub- and supragingival microbial patterns are present in ERA patients that may reflect a pathogenic or immunomodulatory role in early RA progression.
Who was studied?
The study involved 44 Caucasian adults: 22 ERA patients and 22 age-, gender-, and smoking-matched healthy controls. ERA patients had disease onset within two years and met 2010 ACR/EULAR classification criteria. Subjects were recruited from clinical and dental settings in Heidelberg, Germany. Exclusion criteria included biologic DMARD use, poor oral hygiene, recent antibiotics, systemic disease-related periodontitis, and pregnancy or lactation. Microbial samples were collected subgingivally and supragingivally, followed by real-time quantitative PCR targeting 43 oral species and nine major periodontal pathogens.
What were the most important findings?
ERA patients exhibited significantly more severe periodontitis than controls, with increased gingival bleeding, probing depth, and a higher number of missing teeth. Clinically meaningful CAL loss (3.4 mm vs. 2.7 mm; p<0.0001) was observed in ERA patients. Despite similar plaque indices, inflammatory markers such as bleeding on probing were elevated. Microbiologically, subgingival Tannerella forsythia (6.77-fold increase, p = 0.033) and supragingival Streptococcus anginosus (3.56-fold increase, p = 0.028) were enriched in ERA patients. Conversely, protective taxa such as Leptotrichia spp., Rothia dentocariosa, Actinomyces spp., and Lactobacillus gasseri were depleted. These patterns support a shift toward an inflammatory microbial consortium early in RA.
| Microbial Taxa | Enrichment/Depletion in ERA | Implication in ERA Pathophysiology |
|---|---|---|
| Tannerella forsythia | Enriched (6.77-fold) | Associated with severe periodontitis; candidate MMA in ERA |
| Streptococcus anginosus | Enriched (3.56-fold) | Involved in oral inflammation; supragingival MMA |
| Lactobacillus gasseri | Depleted (0.19-fold) | Loss may reduce mucosal barrier protection |
| Leptotrichia species | Depleted (0.34-fold) | Commensal depletion suggests microbial dysbiosis |
| Rothia dentocariosa | Depleted (0.15-fold) | Health-associated microbe; depletion indicates disruption |
| Actinomyces species | Depleted (0.19-fold) | Known oral commensals; potential anti-inflammatory role |
| Corynebacterium durum | Depleted (0.17-fold) | Role in biofilm homeostasis; loss may promote dysbiosis |
What are the greatest implications of this study?
This study reinforces the concept that the oral microbiota in early rheumatoid arthritis displays pathogenic alterations that may contribute to systemic inflammation. Enrichment of T. forsythia and S. anginosus—previously implicated in periodontal disease—suggests they may act as early microbial triggers or modulators of RA pathogenesis. The findings highlight the need for integrating dental surveillance and periodontal interventions into early RA management. Moreover, they emphasize the potential utility of subgingival microbiome profiles as diagnostic biomarkers or therapeutic targets in RA. These microbial signatures should be considered Major Microbial Associations (MMAs) for ERA within the Microbiome Signatures Database framework.