Chew on this: periodontal disease has been linked to the development of RA.
References1. Koziel J, Mydel P, Potempa J. The link between periodontal disease and rheumatoid arthritis: an updated review. Curr Rheumatol Rep. 2014;16:408.2. AraÃºjo VM, Melo IM, Lima V. Relationship between periodontitis and rheumatoid arthritis: review of the literature. Mediators Inflamm. 2015;2015:259074.3. Kaur S, White S, Bartold M. Periodontal disease as a risk factor for rheumatoid arthritis: a systematic review. JBI Libr Syst Rev. 2012;10:1-12.4. Payne JB, Golub LM, Thiele GM, Mikuls TR. The link between periodontitis and rheumatoid arthritis: a periodontist’s perspective. Curr Oral Health Rep. 2015;2:20-29.5. Sugiyama D, Nishimura K, Tamaki K, et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2010;69:70-81.6. Chang K, Yang SM, Kim SH, et al. Smoking and rheumatoid arthritis. Int J Mol Sci. 2014;15:22279-22295.
A large body of literature links periodontal disease to a higher potential for the development of rheumatoid arthritis (RA).1
Scroll through the slides for a review of the evidence.
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Periodontal disease increases the risk of RA. At the same time, periodontal disease is at least 2 times more prevalent among patients with a diagnosis of RA.
In RA, inflammatory leukocyte infiltrates accumulate in the synovial membrane.1,2 Inflammatory mechanisms are also involved in periodontal disease.
Oral hygiene and proliferation of bacterial plaque play an important role in the expression of periodontal disease. Smoking is a contributing factor to both RA and periodontal disease.2
P gingivalis is one of three microorganisms most commonly found to produce periodontal disease. It is the only one known to express the peptide-arginine deiminase (PAD) enzyme that is believed to produce antibodies to citrullinated proteins (ACPAs).
Both periodontal disease and RA are associated with destruction of bone, mediated by the same inflammatory cytokines. The two-hit model suggests a cyclical progression linking the two diseases.
Although the two-hit theory has been supported in the literature, further evidence is needed to confirm it.3,4
Periodontal disease has been associated with excess production of ACPAs, which are believed to trigger or exacerbate RA.1
Numerous studies have shown a correlation between smoking and the risk of developing RA. That correlation appeared to be stronger among men than women and increased with the lifelong exposure to smoking (frequency and duration).
Smoking is also a primary factor influencing the development and severity of periodontal disease that leads to RA.2