Rheumatoid arthritis is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body. Rheumatoid arthritis can affect people of all ages. The cause of rheumatoid arthritis is not known. Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions. In rheumatoid arthritis, multiple joints are usually, but not always, affected in a symmetrical pattern. Chronic inflammation of rheumatoid arthritis can cause permanent joint destruction and deformity. Damage to joints can occur early and does not correlate with the severity of symptoms.
Over half (56%) of people with rheumatoid arthritis (RA) also have periodontitis (a chronic inflammatory disease of the gum and surrounding ligaments and bones that hold the teeth in place), displaying fewer teeth than healthy matched controls, high prevalence of oral sites presenting dental plaque and advanced attachment loss (the extent of periodontal support that has been destroyed around a tooth) (chi square p<0.05), according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. In addition, these patients were found to have significantly higher RA disease activity and anti-CCP (cyclic citrullinated peptide) antibody levels than others with RA who did not exhibit periodontitis (r=0.84, p<0.05; r=0.78, p<0.05).
The study also showed that, after six months of anti-TNF therapy (prescribed to control RA inflammation and destruction), a statistically significant improvement in periodontal status was seen in 20 (80%) of the 25 participants (mean age 41.5+3.7 years; mean disease duration 7.2+4.8 years), suggesting that the biological therapy may also be able to modulate the inflammatory process in the periodontium (the tissues investing and supporting the teeth, including the cementum, periodontal ligament, alveolar bone, and gingival / gums).
Dr Codrina Ancuta of the Grigore T Popa University of Medicine and Pharmacy, Rehabilitation Hospital, Iasi, Romania, who led the study, said: "There is a growing body of evidence to demonstrate an association between periodontal disease and systemic conditions involving inflammatory rheumatic disease (especially RA), cardiovascular disease and diabetes. However, further cross-disciplinary research among rheumatologists and periodontologists is required to fully understand the underlying mechanisms that link RA and periodontitis, and to explore how patients can be managed more holistically using treatments such as anti-TNFs and some lifestyle approached that may simultaneously address both conditions."
The prospective observational study compared 25 consecutive RA patients receiving anti-TNFs with 25 systemically healthy individuals matched for age, gender and periodontal status at baseline and six months, assessing both groups for periodontal status (visible plaque scores, marginal bleeding scores, attachment loss, number of present teeth), and the RA patient group in terms of RA parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP antibodies, disease activity and disability scores). Statistical analysis was conducted in SPSS-14 (a statistical analysis computer programme) p<0.05.
Moderate to Severe Periodontitis may be a Risk Factor for Developing RA in Non-Smokers.
