Rheumatoid Arthritis and Periodontal Disease: A Rheumatologist's Perspective

Abstract

Despite advances in our understanding of the inflammatory events that underlie rheumatoid arthritis (RA), which have led to targeted therapies that more effectively control the condition, the etiology of RA is not fully understood. 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. Studies of the effect of RA treatment on the severity of PD have been limited and conflicting, especially with respect to anti-TNF agents, but indicate the potential for IL-6 as a therapeutic target for both conditions. PD treatment appears to improve clinical and laboratory evidence of RA disease activity, and the response of RA to anti-TNF therapy is abrogated by the presence of PD. Thus, evaluation and treatment of PD can be recommended for all RA patients.

Enhanced dual function of osteoclast precursors following calvarial Porphyromonas gingivalis infection

“…They function as immune regulatory cells in the circulation and differentiate into osteoclasts at the local pro‐osteoclastogenic environment. However, given the increasing evidence suggesting systemic inflammatory bone loss diseases, such as rheumatoid arthritis, as a risk factor for chronic periodontitis and vice versa, it is not unreasonable to hypothesize that increased osteoclast precursors are involved in the association of chronic periodontitis and various inflammatory bone loss diseases . Indeed, patients with active erosive arthritis have a marked increase in the frequency of peripheral blood CD11b + osteoclast precursors .…”

Correlation of Periodontal Disease With Inflammatory Arthritis in the Time Before Modern Medical Intervention

“…Specifically examining RA, Scher et al 1 noted that >75% of patients with RA have moderate‐to‐severe periodontal disease. Many studies have suggested an association between periodontal disease and RA, 1–10 whereas others have disagreed 11–14 . Similarly, association of periodontal disease with ankylosing spondylitis (AS) has been suggested 15–17 …”

“…All previous studies 1–18 represent evaluation of patients in the second half and typically in the last quarter of the twentieth century. Non‐steroidal anti‐inflammatory drugs (NSAIDs), corticosteroids, immunomodulatory drugs, and, of course, biologics were not available in the first half of the twentieth century 26 .…”