Impact of chronic gingivitis management on the cytokine and anti-PPAD expressions in juvenile systemic lupus erythematosus: A six-month follow-up.

OBJECTIVE: To evaluate how chronic gingivitis treatment impacts the oral and circulating cytokine expressions after six-month follow-up in patients with juvenile systemic lupus erythematosus (jSLE) and also to evaluate the circulating expression of anti-Porphyromonas gingivalis peptidylarginine deiminase antibodies (anti-PPAD) before and after treatment. BACKGROUND: Juvenile systemic lupus erythematosus patients present a worse periodontal condition associated with higher gingival crevicular fluid (GCF) levels of interleukin (IL)-1ß, IL-8, granulocyte colony-stimulating factor (G-CSF), interferon-γ and monocyte chemoattractant protein (MCP)-1. MATERIALS AND METHODS: Twenty-one adolescents with jSLE (mean age: 16.2 ± 1.5 years) were recruited. Participants were rheumatologically and periodontally examined. All individuals were clinically diagnosed with gingival inflammation. Chronic gingivitis treatment consisted of supragingival scaling, prophylaxis and oral hygiene instructions. The cytokine levels were determined by bead-based multiplex assays and the anti-PPAD levels by ELISA. Gingival crevicular fluid (GCF) and serum samples were collected at baseline and 6 months after treatment. RESULTS: We observed a reduction in attachment loss, SLE Disease Activity Index (SLEDAI), IL-1ß, IL-10 and MCP-1 GCF levels, and the IL-4 and IL-5 serum levels 6 months after periodontal treatment. On the contrary, a significant increase in GCF expression of IL-4, IL-12, IL-17, IFN-γ and serum levels of anti-PPAD antibody was observed. CONCLUSION: Juvenile systemic lupus erythematosus patients seem to positively benefit from periodontal treatment by a significantly reduced CAL, a GCF reduction of pro-inflammatory cytokines and an increasing of anti-inflammatory ones. However, an increase in the GCF expression of IL-17 and the serum expression of anti-PPAD antibody 6 months after periodontal treatment might negatively affect the treatment outcome of such patients in the long term.

Presence of anti-Porphyromonas gingivalis-peptidylarginine deiminase antibodies in serum from juvenile systemic lupus erythematosus patients

The presence of a biofilm-associated gingival inflammation in patients having juvenile systemic lupus erythematosus (jSLE) might function as a reservoir of anaerobic Gram-negative bacteria such as Porphyromonas gingivalis. Porphyromonas gingivalis also express functional endogenous peptidylarginine deiminase (PAD) enzymes, which catalyzes a citrullination reaction that can lead to formation of citrullinated peptides. We analyzed 30 patients with jSLE (16.2±1.5 years-old) and 29 healthy controls (15.4±2.3 years old jSLE was diagnosed according to the criteria of the American College of Rheumatology. The individuals underwent a full-mouth periodontal examination and were diagnosed with biofilm-associated gingival inflammation. Blood samples were taken and serum levels anti-PPAD IgG were determined by ELISA, and the results were expressed in arbitrary units (AU). The presence of Porphyromonas gingivalis was confirmed using the checkerboard DNA-DNA hybridization. Porphyromonas gingivalis was detected in both groups without any significant difference between them (p=0.58). The median levels of anti-PPAD were 0.54 AU (0.40 - 0.77) in juvenile SLE patients and 0.48 AU (0.26 - 0.97) in the control group (p=0.95). This is the first study to report the presence of anti-PPAD antibodies in serum from jSLEpatient.