摘要 ：
目的：探討表現為邊緣頜骨損失的牙周炎是否早於RA症狀之前出現。此外，我們分析了與對照組相比，在RA症狀出現前個體中RANKL(一種對於骨吸收重要的細胞因子)和抗瓜氨酸肽抗體(ACPA)的受體激活劑的血漿水平。
方法與結果：邊緣顎骨骨量水平在牙科X線片上測量，其中176名受試者中有93名已經發展為RA。在這93名患者中46人記錄了症狀出現前的影像學表現，並且這部分患者性別、年齡和吸煙狀態可以相互匹配。使用ELISA分析血漿RANKL濃度。ROC曲線被用來定義cut-off值。與匹配的參照相比，骨量丟失在從不吸煙者、症狀前RA個體中顯著升高，且骨丟失水平的增加與隨後發生RA的風險更高有關(風險比= 1.06,95%CI 1.01,1.11)。吸煙者沒有發現上述任何關聯。在症狀前RA且RANKL陽性個體中，檢測到更顯著的邊緣顎骨損失，並且RANKL和ACPA陽性的患者表現出更明顯的下顎骨損失。
結論：邊緣顎骨損失先於RA症狀的臨床發作，但差異僅表現在非吸煙者中。 此外，RANKL陽性的症狀前RA患者的下頜骨邊緣喪失程度明顯較高，尤其是ACPA陽性患者。
附原文：
We investigated whether periodontitis, displayed asmarginal jawbone loss, preceded onset of symptoms of RA. Furthermore, we analysed plasma levels of receptor activator of nuclear factor kappa-B (RANKL), a cytokine crucial for bone resorption and of anti-citrullinated peptide antibodies (ACPA) in pre-symptomatic individuals compared with controls. Marginal jawbone levels were measured on dental radiographs from thepremolar/molar regions of the jaws of 176 subjects of whom 93 had developed RA. Of these, 46 had documented radiographs predating symptom onset and sex, ageand smoking status referents could be matched for 45 of them. The plasma RANKL concentrations were analysed using ELISA. The receiver operating characteristic curve was used to define the cut-off value. Compared with matched referents, bone loss was significantly higher in never-smoking, pre-symptomatic subjectsand increasing levels of bone loss was associated with higher risk to develop subsequent RA (hazard ratio=1.06, 95%CI 1.01, 1.11). No association was foundin smokers. In the pre-symptomatic RANKL-positive individuals a significantly higher extent of marginal jawbone loss was detected, and those who were both RANKL- and ACPA positive displayed an even more pronounced jawboneloss. Marginal jawbone loss preceded clinical onset of symptoms of RA but the difference was only manifested in non-smokers. Moreover, pre-symptomaticRA-individuals, who were RANKL positive, displayed a significantly higherdegree of marginal jawbone loss, particularly in ACPA positive individuals.
引自：E Kindstedt,L Johansson,P Palmqvist, et al.Marginal jawbone loss is associated withonset of rheumatoid arthritis and is related to plasma level of receptoractivator of nuclear factor kappa-B ligand (RANKL).Arthritis& Rheumatology,2017.
