Evaluation of salivary flow rate, pH and anti-CCP antibodies in relation to oral manifestations in patients with Rheumatoid Arthritis: A matched case-control study in Sulaimaniyah, Iraq.

Background: Rheumatoid arthritis (RA) affects the oral cavity, mainly through exocrine salivary gland dysfunction, leading to reduced salivary flow rate. Recently, salivary antibodies against cyclic citrullinated peptide (CCP) have been suggested as diagnostic and prognostic tools in patients with RA. Objectives: To assess salivary flow rate, pH, and oral manifestations in patients with RA and evaluate salivary anti-CCP antibody levels as biomarkers of inflammation. Subjects and methods: A matched case-control study was conducted at the Rheumatology Centre in Sulaimaniyah, Iraq, on 90 subjects (50 patients with RA and 40 healthy controls) between January 2021 and January 2022. The oral cavity was examined for signs of oral and temporomandibular joint (TMJ) involvement along with the assessment of the Decayed, Missed, Filled Teeth (DMFT) index and oral health status. Saliva samples were collected from each subject to measure the flow rate, pH, and anti-CCP antibodies using ELISA. Results: The salivary flow rate was substantially reduced in patients with RA. The main oral manifestations include oral ulcerations, tongue redness, dry/cracked lips, buccal mucosal dryness, taste disturbances, angular cheilitis, and candidiasis. TMJ involvement and higher DMFT scores were also more frequent in patients with RA. However, there was no significant difference between the groups regarding the oral hygiene index or salivary anti-CCP antibody levels. Conclusions: Patients with RA exhibit decreased salivary flow rates and generally poorer oral health status. Salivary anti-CCP antibody levels were deficient but without a significant difference between the RA and control groups.