摘要 ：

        目的：探讨表现为边缘颌骨损失的牙周炎是否早于RA症状之前出现。此外，我们分析了与对照组相比，在RA症状出现前个体中RANKL(一种对于骨吸收重要的细胞因子)和抗瓜氨酸肽抗体(ACPA)的受体激活剂的血浆水平。

        方法与结果：边缘颚骨骨量水平在牙科X线片上测量，其中176名受试者中有93名已经发展为RA。在这93名患者中46人记录了症状出现前的影像学表现，并且这部分患者性别、年龄和吸烟状态可以相互匹配。使用ELISA分析血浆RANKL浓度。ROC曲线被用来定义cut-off值。与匹配的参照相比，骨量丢失在从不吸烟者、症状前RA个体中显著升高，且骨丢失水平的增加与随后发生RA的风险更高有关(风险比= 1.06,95%CI 1.01,1.11)。吸烟者没有发现上述任何关联。在症状前RA且RANKL阳性个体中，检测到更显著的边缘颚骨损失，并且RANKL和ACPA阳性的患者表现出更明显的下颚骨损失。

        结论：边缘颚骨损失先于RA症状的临床发作，但差异仅表现在非吸烟者中。 此外，RANKL阳性的症状前RA患者的下颌骨边缘丧失程度明显较高，尤其是ACPA阳性患者。

        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.