Evaluation of Salivary Anti-CCP in Relation to Some Oral Manifestations in Rheumatoid Arthritis Patients, Sulaimaniyah, Iraq

Background: Rheumatoid arthritis (RA) affects the oral cavity, mainly the exocrine salivary gland function causing decreased salivary flow rate. Objectives: To determine the salivary flow rate, pH, and the main oral manifestations in RA patients. Also, to evaluate the level of antibodies to the cyclic citrullinated peptide (CCP) in the saliva. Subjects and methods A matched case-control study was conducted at Rheumatology Centre, Sulaimaniyah, Iraq, on 90 subjects (50 RA patients and 40 healthy controls) from January 2021 to January 2022. The oral cavity was thoroughly examined for signs of oral and temporomandibular joint (TMJ) involvement and to assess the Decayed, Missed, Filled Teeth (DMFT) index and oral health status. Saliva samples were taken from each subject to measure flow rate, pH, and immunological determination of anti-CCP antibodies using ELISA. Results: Salivary flow rate was substantially reduced in RA patients. The main oral manifestations were oral ulcerations, redness of the tongue, dry/cracked lips, buccal mucosal dryness, taste disturbances, angular cheilitis, and candidiasis. In addition, TMJ involvement and DMFT were also suggestively more in the RA patients. There was no significant difference between both groups regarding oral hygiene index and the level of salivary anti-CCP antibodies. Conclusions: Patients with RA exhibited decreased salivary flow rate and generally poorer oral health status.