Periodontal Disease as a Risk Factor for Rheumatoid Arthritis: A Systematic Review

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown aetiology and has a complex multifactorial pathogenesis affecting joints and other tissues. The natural history of rheumatoid arthritis is poorly defined; its clinical course fluctuates and the prognosis unpredictable. Rheumatoid arthritis affects up to 1-3% of the population, with a 3:1 female preponderance disappearing in older age. There is also evidence of a genetic predisposition to the disease. Rheumatoid arthritis is characterised by progressive and irreversible damage of the synovial-lined joints causing loss of joint space, bone and function, leading to deformity. Extracellular matrix degradation is a hallmark of rheumatoid arthritis which is responsible for the typical destruction of cartilage, ligaments, tendons, and bone.Rheumatoid arthritis is characteristically a symmetric arthritis (symmetrical swelling of the joints). Articular and periarticular manifestations include joint swelling and tenderness to palpation, with morning stiffness and severe motion impairment in the involved joints. Extra-articular signs can involve pulmonary, cardiovascular, nervous, and reticuloendothelial systems. The clinical presentation of rheumatoid arthritis rheumatoid arthritis varies, but an insidious onset of pain with symmetric swelling of the small joints is the most frequent finding. Rheumatoid arthritis onset is acute or subacute in about 25% of patients. Early rheumatoid arthritis is characterised by symmetric polyarthritis involving the small joints of the hands and feet with no radiologic changes. Rheumatoid arthritis most frequently affects the metacarpophalangeal, proximal interphalangeal and wrist joints. Although any joint, including the cricoarytenoid joint, can be affected, the distal interphalangeal, the sacroiliac and the lumbar spine joints are rarely involved, which is peculiar because these are some of the most typical targets of seronegative spondylarthropathies, such as psoriatic arthritis and ankylosing spondylitis. The clinical manifestations of rheumatoid arthritis vary, depending on the involved joints and the disease stage. The clinical features of synovitis are particularly apparent in the morning. Morning stiffness in and around the joints, lasting at least 1 hour before maximal improvement is a typical sign of rheumatoid arthritis. It is a subjective sign and the patient needs to be carefully informed as to the difference between pain and stiffness. Morning stiffness duration is related to disease activity. Progression of rheumatoid arthritis can be measured by laboratory tests and clinical evaluation (questionnaires of disease activity and physical examination). Laboratory tests include blood tests for Rheumatoid factor (RF) and Acute-phase reaction tests while clinical evaluation can be measured by the Disease activity using the Disease Activity Score (DAS). Periodontitis is a destructive inflammatory disease of the dental supporting tissues which leads to erosion of bone around teeth resulting in tooth loss. Severe p...

Association between Oral Health Status and Rheumatoid Arthritis

“…이러한 맥락에서 본다면 이 두 가지 질환은 염 증성 사이토카인에 의해 매개되는 골 파괴, 즉 염증을 중심 적인 연결고리로 보는 것과 관련될 수 있다 13) . 병리학적 진 행과정, interleukin 1 (IL-1), 자가항체인 류마티스 인자 (rheumatoid factor) 및 항CCP 항체(anti-cyclic citrullinated peptide antibodies) 또한 공유하고 있는 것으로 알려 져 있다 1,14) .…”

Does Treatment of Periodontal Disease Influence Systemic Disease?

“…115 A 2014 systematic review concluded, based on 5 eligible intervention studies, [112][113][114]116,117 that nonsurgical periodontal treatment leads to significant improvement in both biomarkers and clinical arthritis manifestations, citing reductions in erythrocyte sedimentation rate (ESR) and a trend toward decreasing levels of TNF-a and the 28-joint count disease activity score (DAS28) 118 assessed by CRP or ESR scores. 110 More recent treatment studies confirm these findings, with a significant decrease in TNF-a levels.…”

Managing patients with rheumatoid arthritis

“…10 The periodontal pathogen Porphyromonas gingivalis has been implicated in the aetiology of RA as has, most recently, the gut microbiome. 11,12 Other suggested environmental risk factors include region of birth, birthweight, breastfeeding and socioeconomic status. 13 Genetic factors account for 50% of the risk of RA development, with more than 100 loci for genetic susceptibility identified to date.…”