In the context of a possible causative link between periodontal diseases and rheumatoid arthritis, it is worth noting that though periodontal diseases with associated dysbiotic microflora were prevalent in ancient populations as diverse as the Egyptians, prehistoric Scots, early pre-Columbian Americans, the Roman British, and medieval European populations, [1][2][3][4][5][6] bioarchaeological/paleontological studies have failed to reveal convincing evidence of rheumatoid arthritis. The first recognized description of rheumatoid arthritis dates to the beginning of the 19th century. 7 Owing to a lack of conclusive evidence, there are three hypotheses concerning the origin of rheumatoid arthritis: (a) it has an ancient origin; (b) it has a modern origin; and (c) it originated in the New World and was transmitted to the Old World after Columbus discovered the Americas. Therefore, if periodontal diseases (with pathogens dating back to the Neolithic period) underline development of rheumatoid arthritis, the first hypothesis would gain support in and lend credibility to an anecdotal report attributed to Hippocrates of the successful treatment of joint pain by extraction of bad teeth. Here, we present and critically discuss current research data, either supporting or negating the causative link between periodontal diseases and rheumatoid arthritis, in the context of the underlying inflammatory pathobiology of both diseases and possible involvement of periodontal pathogens.
| RHEUMATOID ARTHRITIS IN THE REFLEC TION OF PERIODONTITIS?Rheumatoid arthritis is a common, systemic autoimmune disease having a reported prevalence ranging from 0.5% to 1% in the adult population worldwide, with a female-to-male ratio of 3:1. This chronic disease is characterized by inflammation of the synovial lining of joints leading to the destruction of cartilage, erosion of bone, pain, and chronic disability. Rheumatoid arthritis usually affects joints in the hands, feet, and wrists, but progression of the disease may also affect the kidneys, skin, lungs, and liver. The disease is strongly associated with cardiovascular damage and other systemic complications, increasing mortality. The etiology of rheumatoid arthritis is complex, and its underlying pathogenic mechanisms are not fully elucidated.However, this disease shares striking similarities with periodontal diseases in its immunological, biological, and genetic background, suggesting a strong association between these two disorders. 8
| Genetic and environmental risk factorsNumerous studies have identified genes implicated in the genetic predisposition to rheumatoid arthritis, the strongest of which is the shared epitope motif, a specific five amino acid sequence in the type II human leukocyte antigen (HLA) of the major histocompatibility complex class II protein. Several alleles are considered to contain the shared epitope motif, many of which are located in the HLA-DRβ1 region. Expression of specific HLA-DRβ1 polymorphisms is associated with increased risk of developing rheumatoid arthriti...