Periodontal disease is four times more common among patients with rheumatoid arthritis than it is among their healthy peers, according to a small study published online in the Annals of the Rheumatic Diseases (August 8, 2012).
Periodontal disease also tends to be more severe in these patients, according to the study authors, from Nizam's Institute of Medical Sciences and Government Dental College in Hyderabad, India.
The researchers based their findings on 91 adults with confirmed rheumatoid arthritis and a comparison group of 93 healthy people, matched for age and sex.
All participants were nonsmokers, as smoking is a known risk factor for rheumatoid arthritis. Smoking is also strongly associated with the production of antibodies, indicative of a systemic reaction to a person's own proteins (ACPAs), and which often predates the development of rheumatoid arthritis by several years. None of the participants had been treated with disease-modifying drugs.
Disease activity was quantified using a specific score and by measuring levels of inflammatory markers. The extent of periodontal disease was assessed by quizzing participants on their symptoms, which included swollen and bleeding gums, sensitive teeth, loose teeth, and a history of tooth loss caused by periodontitis. Periodontal disease was defined as present if the mean pocket depth was 3 mm or more.
Almost two-thirds of the patients (just under 65%) with rheumatoid arthritis had evidence of periodontitis, compared with just over a quarter (28%) of their healthy peers. Patients with rheumatoid arthritis had a 4.28 higher odds of periodontal disease than the healthy controls (64.8% versus 28%, p < 0.001).
The depth of pocketing also was significantly greater in rheumatoid arthritis patients and especially among those who tested positive for ACPA, compared with those in the healthy comparison group. Those who tested positive for ACPA had had their rheumatoid arthritis for longer, had higher levels of disease activity, and higher levels of inflammatory markers than those who tested negative.
Porphyromonas gingivalis is one of the main bacteria behind periodontal disease, and it is also the only organism known to produce an enzyme capable of generating ACPA in gum tissue.
Periodontal disease is more common and severe in rheumatoid arthritis patients than in healthy controls, and it could be a potential environmental trigger in the development and maintenance of systemic inflammation in rheumatoid arthritis, the researchers concluded.
