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Identification of Oral Bacterial DNA in Synovial Fluid of Patients With Arthritis With Native and Failed Prosthetic Joints

Témoin, Stéphanie PhD*; Chakaki, Alia DDS, MSD*; Askari, Ali MD; El-Halaby, Ahmed DDS, MSD*; Fitzgerald, Steven MD‡§; Marcus, Randall E. MD‡§; Han, Yiping W. PhD*∥¶; Bissada, Nabil F. DDS, MSD*

Journal of Clinical Rheumatology: April 2012 - Volume 18 - Issue 3 - p 117–121
doi: 10.1097/RHU.0b013e3182500c95
Original Articles

Objective We examined the presence of bacterial DNA in synovial fluids of native or clinically aseptically failed prosthetic joints from patients having periodontal disease and arthritis to determine whether there is bacterial spread from the oral cavity to the joints.

Methods A total of 36 subjects were enrolled in the study. Among these, 11 were diagnosed with rheumatoid arthritis (RA) and 25 were diagnosed with osteoarthritis (OA). Eight patients with OA and 1 patient with RA had failed prostheses. Synovial fluid was aspirated from the affected hip or knee joint. Pooled subgingival plaque samples were collected, followed by clinical periodontal examination. Bacterial DNA was extracted from the collected synovial fluid and dental plaque samples were followed by polymerase chain reactions and DNA sequence analysis of the 16S-23S rRNA genes.

Results Of the 36 patients, bacterial DNA was detected in the synovial fluid samples from 5 patients (13.9%): 2 with RA (1 native and 1 failed prosthetic joints) and 3 with OA (1 native and 2 failed prosthetic joints). Of these 5 patients, 2 were diagnosed with periodontitis and had identical bacterial clones (Fusobacterium nucleatum and Serratia proteamaculans, respectively) detected in both the synovial fluid and the dental plaque samples. Fusobacterium nucleatum was the most prevalent, detected in 4 of the 5 positive samples. No cultures were done and no patients were treated with antibiotics or developed clinical infection.

Conclusions The present findings of bacterial DNA in the synovial fluid suggest the possibility of organisms translocating from the periodontal tissue to the synovium. We suggest that patients with arthritis or failed prosthetic joints be examined for the presence of periodontal diseases and be treated accordingly.

The possible role of periodontal disease in joint problems is supported by these findings of DNA of oral bacteria in joints without clinical evidence of infection.

From the *Department of Periodontics, School of Dental Medicine, Departments of †Rheumatology and ‡Orthopaedics, School of Medicine, Case Western Reserve University; §Department of Orthopedic Surgery, University Hospitals Case Medical Center; and Departments of ∥Pathology and ¶Reproductive Biology, School of Medicine, Case Western Reserve University, Cleveland, OH.

This study was supported by the Department of Periodontics at Case Western Reserve University and by National Institutes of Health grants RO1 DE14924, KO2 DE16102, and R21 DE17165 to Y.W.H.

The authors declare no conflict of interest.

Correspondence: Nabil F. Bissada, DDS, MSD, Department of Periodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106-4905. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.