Periodontitis-Associated RA
A Link between Peridontal disease and Rheumatoid Arthritis
Maria Flores
DH204
Ms. Ogami
November 16, 2009
Periodontitis-associated RA
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Introduction
Rheumatoid arthritis is a chronic autoimmune disease with inflammation of the
joints and marked deformaties, researchers have found a possible link between
rheumatoid arthritis and periodontal disease. In a recent study, 57 patients with
rheumatoid arthritis and 52 patient’s wihtout RA were examined, it was
suggested that patients with Rheumatoid arthritis had a greater periodontal
attachment loss compared to patients without RA (Pischon et al., 2008). It is also
been found that P. gingivalis a bacteria that is associated with peridontal disease
is the only bacteria known to express the (PAD) Peptidylarginine deimninase
enzyme which is strongly associated Rheumatoid Arthritis (Liao, Feng 2008). The
association between RA and Periodontal disease deserves much interest for
more research since both diseases can lead to detrimental effects. If we as
clinicians can help alleviate symptoms of either one of these diseases it can lead
to a better quality of life.
The link between Periodontal Disease and Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic autoimmune disease characterized by
inflammation of the lining or synovium of the joints; it is believed to result from an
"autoimmune" process in which the body's immune system attacks itself. It is a
system-wide disease that usually last for many years. In some patients, RA
affects such organs as the heart, lungs, and eyes. Patients with active RA often
feel feverish or ill. Women are more likely than men to develop rheumatoid
arthritis possibly connected to flucuaiton of women hormones during pregnancy
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and menopause. Testing and diagnosis for RA include blood test to check for
rheumatoid factor and x-rays to check for bone erosion. Test results can also
produce positive-negative results indicating the possibilities of developing RA in
the future. Periodontal disease is a bacterial infection that destroys the
attachment fibers and supporting bone that hold the teeth in the mouth. Left
untreated, it can lead to tooth loss. Recent research has indicated that both of
these diseases, rheumatoid arthritis and periodontal disease have common
features, both are characterized by symptoms of inflammation due to
inflammatory mediator cells causing pain, swelling and tenderness and
eventually bone destruction. Both disease share similar immune responses
triggered by inflammation targeting the oral cavity or synovial membrane, both
diseases have raised titiers of IL-10, IL1α, tnfα, LTα and low titers of
autoanitbodies to IL-1α, and IL-6. One of the main bacteria that are responsible
for severe forms of periodontal disease is Porphyromonas gingivalis, a gram
negative anaerobic pathogenic bacterium. According to Feng et al. (2008) P.
Gingivalis is the only Prokaryotic orgnism that produces (PAD) Peptidylarginine
deiminase enzyme which is a specific marker for rheumatoid arthritis. Through a
process called Post-transitional conversion, P. Gingivalis converts the
Peptidylarginine enzyme into citrulline (citrullination) an α amino acid which may
suggest that periodontal infection can directly impact people with rheumatoid
arthritis facilitating inflammation and also possibly indicate pathogenesis for RA.
Peridontitis-Associated RA
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In a study,109 subjects were selected to assess an association between RA and
periodontitis, 57 of those subjects had rheumatoid arthritis, eight males and 49
females, Subjects with RA were required to meet at least four criteria of
symptoms for RA which included morning stiffness, arthritis of three or more joint
areas, arthritis of hand joints and radiographic findings. The remaning 52
subjects did not have RA and were composed of 43 females and 9 males. All
subjects were examined and assessed for Clinical attachment loss (CAL),
periodontal disease (PD), lost teeth (n), Plaque Index (PI), bleeding on probing
(BOP), decayed missing filled teeth(DMFT) index, Gingival index (GI) and TMJ
symptoms. The findings indicated according to (table 2) Pischon et al. (2008) that
there was a significant difference in patients with RA compared to the control
group. The association between RA and periodontal disease is brought a lot of
attention to rheumatologist at the Case School of Medicine and University
hospitals Case Medical center where rheumatologist for eight weeks were
observing patients receiving periodontal therapy and found that at the end of
those eight weeks the severity of the arthritis was reduced. In addition, they
suggested that periodontal therapy combined with (DMARD) disease modifying
antirheumatic drugs and (anti-TNF) showed that patients not only had relief of the
RA inflammation, but the periodontal status of these patients was significantly
improved (Case Western Reserve University, 2007, p. 2). Currently there is no
cure for Rheumatoid arthritis but there is a promise of a P. Gingivalis Vaccine.
Severe periodontal disease can be arrested but the bone destruction is
irreversible, in either case both disease need to be monitored closely for major
Periodontitis-Associated Ra
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changes with a specialist and dental practitioner. For the dental health
practitioner, it is especially important to follow up closely with RA patients since
there seems to be evidence connecting periodontal disease with RA being aware
of symptoms that a patient may exhibit like tenderness of the joints in the hands
may indicate a symptom of RA. With the recent evidence of periodontal disease
and RA, Rheumatologist should also refer patients with RA to visit their dentist
for a prescreening to prevent the onset of periodontal disease. Alleviating
symptoms of RA through medication and periodontal therapy will not only
improve the quality of a person’s life but also improve their periodontal health as
well.
Periodontits-associated RA
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References
Case Western Reserve University. (2007). Rheumatology Research. Linking
Rheumatoid Arthritis and Periodontal Disease: Enhancing the Ability to
Treat Both. (From Value of Research published by Case for, Predominant
research). Retrieved from casemed.case.edu/medicine/resrheum.htm
Depinder, K. Modi., Vipinder, S. Chopra., Bhau, Usha. (2009). Rheumatoid
arthritis and periodontitis: Biological links and the emergence of dual
purpose therapies, 20, (1) 86-90.
Gonzalez, D., Tzianabos, O, A., Genco, A, C., & Gibson, C. F. (2003).
Immunization with Porphyromonas gingivalis Capsular Polysaccharide
Prevents P. gingivalis-Elicited Oral Bone loss in a Murine Model.
Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC152101/
Liao, Feng., Zubing, Li., Wang, Yining., Shi, Bin., Gong, Zhongcheng.,
Xiangrong, Cheng., (2008). Porphyromonas gingivalis may play an
important role in the pathogenesis of periodontits-associated rheumatoid
arthritis. Retrieved from www.elsevier.com/locate/mehy. Medical
hypotheses 72 (2009), 732-735.
Mercado, F. B., Marshall, R. I., Klestov, C. A., Bartold, M. P., (2001).
Relationship Between Rheumatoid Arthritis and Periodontitis.Journal of
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Pischon, N., Pischon, T., Kroger, J., Gulmez, E., Kleber, B. M., Bernimoulin, P.
J., et al. (2008). Association Among Rheumatoid Arthritis, Oral Hygiene,
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