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Periodontal Disease and Rheumatoid Arthritis: How Are They Related?

Rheumatology Advisor interviewed Dr Sofat, who suggests that better control of periodontal disease might improve outcomes in rheumatoid arthritis.

Periodontal disease (PD) is a multifactorial chronic inflammatory disorder that progresses beyond an initial stage of gingivitis to a chronic inflammatory process, causing destruction of the alveolar bone and periodontal connective tissue, and ultimately resulting in tooth loss. Epidemiologic and case-control studies have provided evidence that individuals with PD are at significantly greater risk for a wide variety of systemic diseases, including gastrointestinal and pancreatic cancers, type 2 diabetes, cardiovascular disease, and inflammatory rheumatologic diseases, particularly rheumatoid arthritis (RA).1-3 Results from a 2016 meta-analysis showed that individuals with RA had a 13% greater risk for periodontitis compared with non-RA control patients.4

Although no definitive causal or permissive link between PD and systemic inflammatory disease has been established, it has been hypothesized that in patients with PD, local periodontal pathogens and inflammatory mediators may spill into the circulatory system via the damaged sulcular epithelium, increasing the level of systemic inflammation and thus raising the risk for the development of systemic inflammatory diseases.5 The association between PD and systemic inflammatory diseases is likely also grounded in their shared risk factors, which include age, tobacco use, lifestyle, and socioeconomic status.2

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