Researchers are getting closer to understanding the underlying factors that connect rheumatoid arthritis and periodontal disease, according to an article published in Current Oral Health Reports.

In the article, entitled “Rheumatoid Arthritis and Periodontal Disease: A Rheumatologist’s Perspective,” researchers discussed recent findings surrounding the connection between rheumatoid arthritis and periodontal disease, including the hypothesis that there is a direct, potentially causal association between the two diseases.

The relationship between gum disease and rheumatoid arthritis has long been discussed as both potentially etiological and causal, as the two conditions share common risk factors and immunological processes.

• Both are characterized by inflammatory markers, including Il-1, Il-6, TNFα
• Patients with rheumatoid arthritis are more likely to have periodontal disease, and vice versa.
• “Patients with active RA demonstrate significantly increased frequency and severity of periodontal diseases as well as tooth and alveolar bone loss.”
• Bacteria from the mouth are able to translocate to the knee and have been found in patients with RA.

Highlighted in this article was a lengthy discussion of a recently-identified antibody system that seems to directly link the “shared pathogenesis” of the two chronic inflammatory conditions.

With the discovery that serum antibodies to citrullinated peptides (ACPA) are highly specific for RA and that Porphyromonas gingivalis, the major pathogen responsible for periodontitis (PD), contains the enzyme responsible for the citrullination of peptides, a plausible explanation for observations of increased incidence and severity of PD in RA patients and an appreciation of pathogenic similarities between the two conditions has emerged.

From a rheumatologist’s perspective, the paper continues, there are four main non-pharmacological measures that might improve disease control in patients with rheumatoid arthritis:

• Fatty acid supplementation
• Smoking cessation
• Weight loss
• Evaluation and treatment of periodontal disease

That rheumatologists are now recommending the evaluation and treatment of periodontal disease for all RA patients is a significant milestone in the oral-systemic health movement. When care is coordinated between medical and dental professionals, improved outcomes, healthier patients, and lower healthcare costs often result.

And, as the study authors noted, this greater understanding of the PD-RA link will hopefully change the course of conversation from treatment to prevention.

Sources: Rheumatoid Arthritis and Periodontal Disease: A Rheumatologist’s Perspective