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RA and Periodontal Disease: What's the Link?

Medically Reviewed by Melinda Ratini, DO, MS on March 25, 2022

Rheumatoid arthritis (RA) and gum disease are seemingly unrelated conditions. But research shows that the two have certain bacteria in common. These germs – including P. gingivalis and Aggregatibacter actinomycetemcomitans (Aa) – can trigger both periodontal disease and the inflammation found in RA.

One study found that if you have RA, you are twice as likely to have gum disease as those without it. Another study found that 65% of people with RA also had gum disease, compared to only 28% of people without RA. In both studies, experts found that the severity of periodontal disease was also worse in people with RA.

What’s the link Between RA and Periodontal Disease?

Researchers discovered that RA might not start in your joints. Instead, data shows that the inflammatory disease might happen due to autoantibodies – antibodies that react with your own body, instead of infections – made in other parts of your body (like your digestive tract or your lungs).

The microbes in your mouth create autoantibodies. This happens because a type of bacteria in your mouth, called P. gingivalis, contains peptidyl-arginine deiminase (PPAD), an enzyme that changes proteins in your body. Once this change occurs, your body sees the proteins as a threat. Experts call this process “citrullination.” It can lead to the creation of antibodies against proteins in the lining of your joints. Citrullination causes proteins to be more likely to cause an immune response that harms this joint lining.

Experts found bacteria from your mouth in the fluid between your joints (called synovial fluid) in people with RA and other forms of arthritis. They believe that the bacteria moves through damaged gum tissue, enters into your bloodstream, and then escapes to other parts of your body.

P. gingivalis can lead to earlier onset, quicker progression, and more intense RA. Because of this, your bones and cartilage could become more damaged.

But it’s still not clear whether one condition directly leads to the other. Instead, experts have two major theories on how RA and periodontal disease affect each other:

  • In some people, an immune response against citrullinated proteins could lead to RA. This may also be the reason for inflammation in your body with RA. This theory suggests that periodontal disease can cause RA.
  • RA might affect your gums, just like it harms your joints. This could be why some people with severe RA also have gum disease. This theory would imply that RA can lead to periodontal disease.

What Are Symptoms of RA and Periodontal Disease?

Studies show that symptoms and other factors of periodontal disease (such as bleeding gums, gingivitis, and depth of tooth pockets) are more intense in people who also have RA. Similarly, there is usually more P. gingivalis in your body right before your RA symptoms begin to show.

The severity of your periodontal disease is often in line with the activity of your RA. This means that if your RA is more active, it’s likely that your periodontal disease will also worsen.

What Are the Risk Factors of Periodontal Disease and RA?

While each condition has its own, periodontal disease and RA may share some of the same risk factors. These may include:

Genetic risk factors. If you have a gene called HLA-DRB1, you may be more at risk for both conditions. This gene tells your body how to make a type of protein that helps your immune system function.

Environmental factors. Socioeconomic status, obesity, and smoking might increase your chances of getting RA or periodontal disease. Smoking also makes gum disease and RA worse if you already have either or both conditions.

Prevention and Treatment of Periodontal Disease With RA

Research suggests that nonsurgical periodontal disease therapies, like laser treatments or deep cleaning under your gumline, improve some factors of RA. One study looked at people with periodontal disease who have RA with moderate to high disease activity and low disease activity. For RA with both moderate to high and low disease activity, experts found that nonsurgical periodontal disease therapies may lower your:

Erythrocyte sedimentation rate/C-reactive protein. This is a marker for inflammatory conditions. Doctors use these to diagnose and monitor RA.

Tumor necrosis factor (TNF) levels. TNF is a protein that causes inflammation in your body. It plays many roles in the life cycle of your cells.

Disease Activity Score. This measures how active your RA is on a scale from 0-10. It allows your doctor to gauge how well you respond to a certain treatment.

On the flip side, there may be a link between the severity of your periodontal disease and the usefulness of RA medication. Long-term gum inflammation could affect how well medication for RA works. Because of this, you may have more RA symptoms since your treatment won’t be as successful.

To control or prevent periodontal disease, it’s important that you see your dentist regularly. This is especially true if you have RA. The quicker your doctor finds gum disease, the faster they’ll be able to treat it.

The best way to prevent periodontal disease is through good oral hygiene and regular dental cleanings with your dentist or dental hygienist (about every 6-12 months).

If you have RA, your dentist might suggest that you schedule visits more often. It’s important to tell your doctor if you notice any bleeding or other changes in your brushing and flossing routine.

If your doctor finds that you have mild gum disease, your treatment plan will be pretty simple. You’ll have to keep a good oral hygiene routine: brush your teeth at least twice a day (in the morning and at night) and floss your teeth once a day (at night). They may also give you other pointers to take care of your teeth and gums.

They’ll most likely also give you a deep teeth cleaning. This will get rid of any plaque. They can show you the best way to clean your teeth and avoid plaque buildup. Your doctor will take into consideration any obstacles you may have due to your RA.

For severe gum disease, your doctor will give you extra dental treatment. This might include surgery.

A lot of people don’t realize that they have gum disease. Because of this, it’s important to check your teeth and gums often in a mirror. Look for changes in color or texture. To prevent periodontal disease and any effects it may have on RA, always let your doctor know if you see any changes in your oral health.

Show Sources

SOURCES:

Arthritis Foundation: “Mouth Bacteria May Trigger RA.”

Current Rheumatology Reports: “The Link Between Periodontal Disease and Rheumatoid Arthritis: An Updated Review.”

Nature Clinical Practice. Rheumatology: “Nature and functions of autoantibodies.”

Current Opinion in Rheumatology: “Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions.”

Oral Diseases: “Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients.”

Cleveland Clinic: “Did Gum Disease Cause My Arthritis?”

Arthritis Research & Therapy: “Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case–control study.”

National Rheumatoid Arthritis Society: “Gum Disease.”

Mayo Clinic: “Periodontitis.”

Medline: “HLA-DRB1 gene.”

Pediatric annals: “Erythrocyte sedimentation rate and C-reactive protein: how best to use them in clinical practice.”

Acta Pharmacologica Sinica: “Tumor necrosis factor and cancer, buddies or foes?”

American College of Rheumatology: “Disease Activity Score (DAS)/Disease Activity Score in 28 joints (DAS28).”

Johns Hopkins Rheumatology: “Gum disease linked to rheumatoid arthritis.”

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