Around 1.3 million Americans have been diagnosed with rheumatoid arthritis (RA). This is an autoimmune disease and is a form of inflammatory arthritis. It causes the immune system to attack the body’s own tissues, especially the thin membrane which lines the joints. As a result, fluids can build up in the joints, causing inflammation and pain. It’s a chronic condition and is systemic in that it can affect any area within the body. RA can be very debilitating and can cause deformity in joints and disability. Researchers recently discovered a link between periodontal disease and RA1
, and have found people suffering from this condition are nearly 8 times as likely to be diagnosed with periodontal disease.
One particular study looked at the oral health of 57 patients suffering from rheumatoid arthritis, as well as 52 healthy control subjects. The study took into account various factors including tobacco use, lifestyle, gender, and age. It also took into account the fact that people suffering from RA are likely to have less manual dexterity and might be less able to clean their teeth thoroughly. The study found that although poor oral hygiene may partially account for this link, there are likely to be other factors involved. Treating periodontal disease can sometimes help lessen the pain caused by RA, and can help ease the stiffness. It is also thought that some of the drugs used to treat this condition could help periodontitis.
One particular toxin found in inflamed areas in RA sufferers is called tumor necrosis factor-alpha (TNF- α). This toxin can aggravate existing infections, or initiate new infection sites, and RA sufferers are frequently prescribed drugs designed to block the production of this toxin. A clinical study2 assessed 40 patients suffering from moderate to severe periodontal disease and RA. Participants were divided into four groups, two of which were prescribed the drug which blocks the production of TNF- α, while the two other groups didn’t receive this medication.
Each of these two groups was split into two, and half received treatment for their periodontal disease, while the other half didn’t receive any treatment until the study was over. Those receiving periodontal disease reported that symptoms of RA improved, regardless of whether or not they had been prescribed the drug blocking the production of TNF- α. Those participating in the other group, and who didn’t receive any treatment for their periodontal disease showed significant improvement if they were receiving the anti-TNF- α drug, compared to those who weren’t prescribed this drug.
Another study recently found oral bacteria DNA3 in the synovial fluid of joints in patients suffering from both arthritis and periodontal disease. This suggests that the periodontal bacteria can migrate from the periodontal tissue to the membranes lining the joints.
There are definitely similarities between the two diseases, as both are inflammatory conditions affecting the immune system, and both are systemic. Both are able to destroy soft and hard tissues through this inflammation. Physicians had long suspected a connection between the two, as they had already seen the positive effect periodontal treatment could have on RA sufferers, and conversely, the positive effect drugs prescribed for RA could have on periodontitis.
These results should encourage RA sufferers to be extra vigilant over their daily oral health regime, and will hopefully prompt them to see a dentist at least twice a year. The president of the American Academy of Periodontology believes that medical and dental professionals should collaborate over the treatment of RA patients to ensure the correct procedures are applied to give the best levels of general and oral health.
