Compared with healthy adolescents, patients with juvenile idiopathic arthritis (JIA) have increased gingivitis despite demonstrating oral hygiene, according to study results published in Pediatric Rheumatology. Differences in microbial profile specific to this patient population further support a possible association between gingival inflammation and JIA.
The study included data of adolescents aged 10 to 18 years, with oligoarticular, extended oligoarticular, and polyarticular JIA (n=85), as well as a control cohort that included pediatric dental patients (n=62) and healthy child volunteers (n=11). Dental providers performed oral examinations, calculating gingival indices, plaque indices, community periodontal indices, and bleeding on probing. Patient/parent-reported health characteristics were also collected, including factors that play a role in oral health. Investigators further analyzed microbial profiles with supragingival plaque samples, using 16S rRNA gene sequencing. The variance model analysis was used to test differences between bacteria genera in polyarticular JIA and the healthy control group.
Compared with pediatric dental patients, patients with JIA had significantly higher bleeding on probing scores, indicating increased gingivitis even after adjusting for demographic characteristics (P =.02). In a linear regression analysis, the adjusted difference in mean bleeding on probing scores between the JIA cohort and control cohort was not statistically significant; however bleeding on probing scores trended toward being higher for the JIA cohort. Based on dental indices, patients with JIA did not have overall worse oral hygiene and had better gingival indices. Overall, there was no association between JIA disease activity and dental index scores.
Compared with healthy participants, analysis of plaque microbiota in patients with JIA revealed higher plaque microbial diversity. While the JIA cohort had more abundance of bacteria belonging to genera Streptococcus, Haemophilus, and Kingella, the healthy control cohort had higher levels of bacteria belonging to the genera Actinomyces and Corynebacterium. In the polyarticular JIA group, bacteria belonging to the genera Porphyromonas and Rothia were more abundant, whereas in the control group, bacteria belonging to the genus Prevotella were more abundant.
Study limitations included the cross-sectional design with a diverse population of patients who were diagnosed with JIA a few years before participation and the fact that not all JIA subtypes were included in the sample. The sizes of the control groups were small and unpredicted mismatches may have limited the findings. Data on the frequency of dental care were not estimated. Finally, multiple comparisons in the microbiome study were not corrected for, and suggested associations should be confirmed in additional patient cohorts.
Elevated gingival inflammation in patients with JIA was found independent of dental hygiene and general oral health. Investigators indicated that the variation in microbial profile in this patient population may reveal a possible association between gingivitis and synovial inflammation.
“Understanding the role of oral pathogens in triggering and perpetuating chronic inflammation in JIA could lead to better approaches to prevention and treatment, but will require a better understanding of the immune responses to candidate oral microbes,” they concluded.
Grevich S, Lee P, Leroux B, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol. 2019;17(1):81.