Rheumatoid arthritis – an update for general dental practitioners

Abstract

Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder which significantly impacts patients' lives and can lead to permanent disability. Inflammation in RA not only affects joints; but can affect organs including the heart and lungs. Early diagnosis, initiation of intensive drug therapy, and a multidisciplinary care approach have vastly improved the long-term prognosis for those living with the condition. However, RA patients often present with co-morbidities which add to the complexity of clinical management. Orofacial conditions associated with RA which dental professionals need to be aware of include periodontal disease, temporomandibular dysfunction and salivary gland dysfunction. In this article, we provide information on RA, oral health in RA and guidance on how best to manage patients with RA in general dental practice.

Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis

“…5 Some studies have reported the activity of periodontal pathogens and the presence of inflammatory cytokines [interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and others] in systemic inflammatory diseases. 6 Cardiovascular diseases, such as atherosclerosis, showed associations with periodontitis through inflammatory markers; immune markers also presented in rheumatoid arthritis (RA), 6 especially C-reactive protein and IL-1β.…”

Common Medical and Dental Problems of Older Adults: A Narrative Review

“…Rheumatoid arthritis is a chronic inflammatory auto-immune destructive disease affecting multiple joints [34]. The older adult population with rheumatoid arthritis can be further divided into elderly-onset type which manifests after the age of 60 and young-onset type which starts at 20-40 years old [35].…”

“…It also associates with oral complications such as periodontitis, temporomandibular joint dysfunction and its treatment can lead to methotrexate-induced oral ulceration. Moreover, the immunosuppressive effect of medications such as methotrexate and tumor necrosis factor (TNF)-α antagonists can further worsen the oral conditions [34].…”

“…Rheumatoid arthritis and periodontitis show some similarities as both are chronic inflammatory diseases leading to connective tissue destruction and share similar risk factors such as smoking and socioeconomic status [34]. A study showed that periodontal disease increased the risk of having rheumatoid arthritis by 69% and it may be due to their shared inflammatory pathway [7].…”

“…The prevalence of degenerative temporomandibular joint disease in people with rheumatoid arthritis ranged from 45% to 93% [37], which is presented as limited mouth opening, tenderness, muscle spasm and clicking sound/crepitus. This further complicates oral hygiene care [34]. Xerostomia is commonly found in people with rheumatoid arthritis.…”