Relationship between Periodontitis and Rheumatoid Arthritis: Review of the Literature

Abstract

Periodontitis (PD) and rheumatoid arthritis (RA) are immunoinflammatory diseases where leukocyte infiltration and inflammatory mediators induce alveolar bone loss, synovitis, and joint destruction, respectively. Thus, we reviewed the relationship between both diseases considering epidemiological aspects, mechanical periodontal treatment, inflammatory mediators, oral microbiota, and antibodies, using the keywords “periodontitis” and “rheumatoid arthritis” in PubMed database between January 2012 and March 2015, resulting in 162 articles. After critical reading based on titles and abstracts and following the inclusion and exclusion criteria, 26 articles were included. In the articles, women over 40 years old, smokers and nonsmokers, mainly constituted the analyzed groups. Eight studies broached the epidemiological relationship with PD and RA. Four trials demonstrated that the periodontal treatment influenced the severity of RA and periodontal clinical parameters. Nine studies were related with bacteria influence in the pathogenesis of RA and the presence of citrullinated proteins, autoantibodies, or rheumatoid factor in patients with PD and RA. Five studies investigated the presence of mediators of inflammation in PD and RA. In summary, the majority of the articles have confirmed that there is a correlation between PD and RA, since both disorders have characteristics in common and result from an imbalance in the immunoinflammatory response.

Plant-derived pectin nanocoatings to prevent inflammatory cellular response of osteoblasts following <em>Porphyromonas gingivalis</em> infection

“…[3][4][5] In PD and RA patients the degradation of connective and mineralized tissue is observed. 6 Increased alveolar bone volume loss has recently been shown to be associated with the occurrence of a Gram-negative, black-pigmented, strict anaerobic bacterium P. gingivalis. [7][8][9] The pathogenic effect might be induced indirectly through multiple virulence factors, such as lipopolysaccharides (LPSs), fimbriae, and proteases, as well as through direct interaction with the host's soft and hard tissues.…”

Factors associated with the risk of gingival disease in patients with rheumatoid arthritis

“…Studies investigating the link between gingival disease and RA reported a significantly higher prevalence of gingival disease among RA patients compared with osteoarthritic controls [12]. In a systematic review of 26 studies, 24 studies showed a significant association between gingival disease and RA [21]. Additionally, a systematic review of 19 studies showed a positive outcome of gingival disease treatment on the clinical features of RA [18].…”

“…These inconsistencies are thought to be due to differences in sample sizes, demographics, disease criteria, and in adjustments for confounding factors between studies [16]. Interestingly, mechanical periodontal treatment, such as ultrasonic scaling and root planning for gingival disease, also attenuated the severity of RA [21]. …”

Managing patients with rheumatoid arthritis

“…49 Due to their immunosuppressive effects, RA medications can promote periodontitis, candidosis and oral ulceration aided by a lack of saliva. 50 The three main oral conditions associated with RA are discussed below.…”