Periodontitis and Rheumatoid Arthritis-Mechanistic Evidence.

Area of Science:

• Oral Health and Immunology
• Rheumatology
• Microbiology

Background:

• Periodontitis and rheumatoid arthritis (RA) share an association in susceptible individuals.
• Chronic inflammation and subgingival bacterial infection are key factors in this relationship.
• The
• two-hit
• model proposes inflammation and infection contribute to RA initiation and progression.

Purpose of the Study:

• To review the inflammatory and microbial mechanisms linking periodontitis and RA.
• To propose an updated framework integrating inflammation, dysbiosis, and autoimmunity.
• To elucidate the role of microbial dysbiosis and protein modifications in RA pathogenesis.

Main Methods:

• Narrative review of current evidence.
• Critical examination of inflammatory mechanisms.
• Analysis of microbial contributions and dysbiosis.

Main Results:

• Periodontitis-associated microbial dysbiosis promotes protein citrullination, carbamylation, and MAA adducts.
• These modifications can induce autoantibodies preceding RA onset.
• Subgingival bacteria may translocate, modify proteins, stimulate autoantibodies, and exacerbate inflammation in joints.

Conclusions:

• Inflammation, dysbiosis, and autoimmunity are intricately linked in the periodontitis-RA axis.
• Subgingival bacteria and their products play a significant role in RA development and progression.
• An updated framework highlights the synergistic interplay between oral health, microbial factors, and systemic autoimmune responses.