Rheumatoid Arthritis and Periodontal Disease

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Does gum disease have anything to do with Rheumatoid Arthritis?

teethSome of the popular studies presented at the ACR meeting last November examined the relationship between periodontal disease and Rheumatoid Arthritis. Is there a relationship? And what is it?

Over the last few years, it has been shown that RA patients are more likely to have gum inflammation. That makes sense: we can have eye inflammation, joint inflammation, inflamed organs and veins… But when we notice correlation, we want to know which comes first – the chicken or the egg?

You have probably seen one of the articles flying around the web over the last few months touting the association between Rheumatoid Arthritis and periodontal disease so I’ve wanted to bring the story to you. Various studies claim that either one leads to the other. One claimed that treating gum disease relieves RA symptoms. I’ve been trying to figure out exactly what the explanation is so that I could give you the facts. I don’t think it’s perfectly clear yet, but here is a fascinating theory.

Prominent rheumatologist says periodontal disease may trigger Rheumatoid Arthritis

According to Dr. Gerald Weissmann, who spoke at ACR, the connection between Rheumatoid Arthritis and periodontal disease may be thus: “Perhaps the humoral response to oral bacteria provides a stimulus for the development of Rheumatoid Arthritis. How might that happen? …namely citrullinated proteins.” He continues: “Autoimmunity to specific citrullinated proteins gives the first clues to the etiology of Rheumatoid Arthritis.”

Weissmann outlines the recent wave of clues regarding periodontal disease as a trigger for Rheumatoid Arthritis:

  1. “Antibodies to citrullinated alpha-enolase peptide 1 are specific for Rheumatoid Arthritis and cross-react with porphyromonas gingivalis enolase.” Lundberg K., Kinloch A., Fisher, B.A., et al. Arthritis  Rheum. 58: 3009-19 2008.
  2. “Associations of P. gingivalis titers with RF, antiCP suggests that infection with this organism plays a role in disease risk and progression in RA.” Mukuls TR, Payne, J.B., Reinhardt, R. A. et al Int. Immunopharmacol. 9:38-42 2009.
  3. “Antibodies to Porphyromonas gingivalis are Associated with Anticitrullinated Protein Antibodies in patients with Rheumatoid Arthritis and their Relatives.” Hitchon et al J Rheumatol 37:1105-1112 2010.

Note: You can read abstracts from the ACR meeting which discuss Rheumatoid Arthritis and periodontal disease at this link on the ACR site. There are a few relevant abstracts there. It is a searchable PDF, so you can search “periodontal” to find every mention.

RA patients at risk for periodontal disease because of our fingers too

Some of us find daily gum care very difficult. We might need special tools to help with flossing and brushing. A water-pic type tool is a good idea.

Here’s what WebMD says about gum disease and Rheumatoid Arthritis: “People with rheumatoid arthritis (RA) are eight times more likely to have gum disease than people without this autoimmune disease. Inflammation may be the common denominator between the two. Making matters worse: people with RA can have trouble brushing and flossing because of damage to finger joints. The good news is that treating existing gum inflammation and infection can also reduce joint pain and inflammation.”

Bottom line on periodontal disease and Rheumatoid Arthritis

Something triggers RA – possibly more than one thing. Smokers are more likely to get RA. Maybe that makes sense if smoking increases oral bacteria or weakens something else in the mouth. Sjogren’s is also associated with RA and dry mouth also leads to more gum disease. And yet, there are RA patients with healthy gums and many who have gum disease who do not develop RA. It’s obviously not simple – especially when we consider that infants without teeth develop forms of this disease.

Recommended reading:

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Kelly Young. All rights reserved.

This entry was posted on Friday, January 28th, 2011 at 6:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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