Periodontitis and rheumatoid arthritis: epidemiologic, clinical, and immunologic associations

THE PURPOSE OF REVIEW: Rheumatoid arthritis (RA) is a prevalent autoimmune-mediated, chronic inflammatory disorder that has been found in multiple epidemiologic studies to be associated with periodontal disease (PD). Despite the extensive epidemiologic evidence, the biologic basis of this association remains unclear. This article focuses on new insights into the potential mechanisms underlying the association between PD and RA.

Chronic periodontal and synovial inflammation share many common pathologic, cellular, and molecular features. In particular, the mechanisms involved in the destruction of the adjacent connective tissues are quite similar. Recent studies have shown anti-citrullinated protein antibodies (ACPA) that are highly specific for RA are detectable years before disease development. Emerging evidence suggests the oral pathogen porphymonas gingivalis may serve to break immune tolerance or amplify autoimmune responses to citrullinated antigens and, in turn, ultimately initiate RA in genetically susceptible persons.

Recognition of the association between RA and PD on both a clinical and biologic level may provide new opportunities for intervention that will modify the course of both of these prevalent chronic inflammatory disorders. Furthermore, an enhanced understanding of the early events that initiate RA may result in strategies that prevent disease-onset.