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Rheumatoid Arthritis and Periodontal Disease


A recent study from the University of Dental Medicine and university Hospital Geneva Switzerland, shows that periodontal disease is a significant risk factor in the development of Rheumatoid Arthritis.

Rheumatoid Arthritis and Periodontal Disease are two common chronic inflammatory diseases affecting a significant percentage of the US population where the body’s immune system attacks it’s own tissues. This study reveals that in individuals with periodontal disease, there is an increased risk of developing Rheumatoid Arthritis because of the similarity in the inflammatory cells and proinflammatory cytokines that drive chronic bone destruction in RA and gum destruction in periodontitis.

A bacteria called Porphyromonas gingivalis a leading cause of periodontal disease produces a protein called P.gingivalis peptidyl-arginine deiminase (PPAD) which has the ability to convert arginine in protein to citrulline. This alteration of arginine results in the down regulation of said protein and upregulation of immune invasion.

Chronic exposure to citrullinated protein at periodontitis sites predispose susceptible individuals to the development of antibodies and the initiation of RA.

The evidence is now substantial that majority of Rheumatoid Arthritis cases are triggered by auto immune response to citrullinated proteins. Such proteins are generated under physiological conditions but the loss of tolerance in genetically susceptible individuals initiates the generation of auto antibodies against these citrullinated proteins (ACPA) in the synovia and subsequent development of RA.

So if oral bacteria is implicated in the development of RA, and the inflammation in the mouth results in inflammation in the joints, one might suspect that eliminating inflammation in the mouth somehow would help prevent or treat RA. This would be correct as researchers at Case western University school of dental medicine found that patients receiving non surgical treatment of their gum disease reported significant improvement in their RA symptoms than those who only received treatment for their RA.

More research is still needed in this field however in order to better understand how treating periodontitis improves Rheumatoid Arthritis, and if efforts to prevent periodontitis might also help with Rheumatoid Arthritis.

For this reason it is important for individuals with RA and their doctors to work together to prevent or eliminate periodontal disease.

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