“Periodontitis and Rheumatoid Arthritis: Epidemiologic, Clinical, and Immunologic Associations”
Source: Compendium of Continuing Education in Dentistry. 2009 May;30(4):188-197 PerioFrogz Issue No.: 0809
Author By: Smolik I, Robinson D, El-Gabalawy HS
Overview:
Previous studies have demonstrated an association between periodontal disease, (PD) and rheumatoid arthritis, (RA). This article examines the potential mechanisms underlying this association.
Summary of research:
- Recent research demonstrated the presence of antibodies highly specific for RA years before disease development
- Emerging evidence suggests the periodontal bacteria P. gingivalis (Pg) initiates RA in genetically susceptible individuals, by increasing autoimmune responses.
- Pg. is the only pathogen known to contain an enzyme which catalyzes the reaction that leads to a cascade of events, culminating in the auto immune process that destroys soft tissue and bone in RA.
- PD and RA are genetically related, evidenced by the same gene cluster variations being present in individuals with both diseases.
Results and Conclusions
- The chronic inflammatory lesions common to PD and RA are strikingly similar; sharing many common pathologic, cellular and molecular features, both leading to soft tissue and bone destruction.
- The clinical association between the two diseases is complex and may be related to biological factors, especially shared genetic risk.
- Periodontal disease is an important modifiable risk factor for RA development.
Key take-aways:
The authors examined PD and RA in several patient populations. They found that both diseases share common risk factors including genetics, smoking and age. Biologically plausible mechanisms for the initiation of RA by the periodontal pathogen, Pg., were proposed. P. gingivalis is the only known pathogen to produce an enzyme capable of modifying specific proteins which then results in the autoimmune processes to these modified proteins, that precedes the onset of RA. If further research affirms the initiation of RA by PD, periodontal disease prevention and early treatment may lead to the prevention of rheumatoid arthritis in susceptible individuals.
Implementation strategies:
“Rheumatoid arthritis (RA) is the most common form of chronic inflammatory arthritis. More than 2 million people in the United States suffer with RA. It generally affects more women than men and typically develops between the ages of 25 and 50. RA itself is not inherited, but the genes that may make someone more likely to develop the disease can be passed from parent to child. Scientists believe it is unlikely that genes alone bring about RA, research continues to discover what role genes and other conditions may play in the development of the crippling disease”, says William S. Wilke, MD.
“Rheumatoid arthritis occurs when white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into the membranes that surround your joints. The blood cells appear to play a role in causing the joint (synovium) to become inflamed. (image A) The inflammation causes the release of proteins that, over months or years cause the synovium to thicken. The proteins can also damage the cartilage, bone, tendons and ligaments near your joint. Over time the joint loses its shape, rheumatoid nodules may appear (image B) and alignment may eventually be destroyed.
Doctors don't know what causes this process that leads to rheumatoid arthritis. It's likely that rheumatoid arthritis occurs as a result of a complex combination of factors, including your genes, your lifestyle choices, such as smoking, and things in your environment, such as viruses”, reports a team from the Mayo Clinic.
From our perspective as dental professionals, the potential impact of prevention and early intervention of PD on the prevention of RA is huge. Consider the possibility that treating someone with early signs of PD and a family history of RA may potentially be spared its horrible crippling effects like Leukocytoclastic vasculitis (image C).
While we wait for further research to affirm these conclusions we have yet one more reason to treat and prevent PD. Why would any Dental Health Care Provider wait?
Please visit
periofrogz.com to download a ‘Progression of Rhuematoid Arthritis’ flow chart for an overview of the cascade of events leading to RA and the physical effects of this horrible disease. This flow chart may be used for patient education so your patients can more easily understand the progression of RA.
This issue of PerioFrogz is dedicated to the memory of Donna Klaus, RDH, a wonderful friend, colleague and clinician, who recently passed due to complications related to RA.
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