What Is The Connection Between Rheumatoid Arthritis And Gum Disease?

Arthritis is an inflammatory condition that largely affects the joints of the body. The main symptoms of arthritis include joint swelling, pain and stiffness. One of the most common subtypes of arthritis is rheumatoid arthritis, which is an autoimmune disease.

Autoimmune diseases are conditions in which the immune system, which is normally designed to protect us from foreign pathogens, starts to attack our own body. Unfortunately, in some people, arthritis goes beyond the joints and starts to affect other part of the body as well.

Here's what some of the studies that have been conducted on the topic tell us:

• In one study with 636 patients with early arthritis, researchers found that 24.2 percent had 10 or fewer teeth, 16.1 percent had 11 to 20, 36.3 percent had 21 to 27 teeth, and 23.3 percent had 28 or more teeth. Researchers found that patients with the fewest teeth had the worst prognosis, while people that had 10 or less teeth had the most severe arthritis.
• In another study, researchers found that tooth loss was associated with joint symptoms in a collection of 366 first-degree relatives of patients with rheumatoid arthritis. Patients with any swollen joints had an average of 26 teeth. On the other hand, patients with no swollen joints had an average of 29 teeth.
• Another study found that 6,616 men and women who did a test for periodontal disease and were found to have moderate to severe periodontitis were twice as likely to develop rheumatoid arthritis compared to patients with mild or no periodontitis.

So is there a connection between gum disease and arthritis? If so, why?

Doctors believe that there is clearly a relationship between periodontal disease and rheumatoid arthritis. Many doctors believe that patients with rheumatoid arthritis who develop periodontal disease do so because of the rheumatoid arthritis.

• One of the explanations is that patients with arthritis in their hands, which makes them stiff and painful, are likely to have worse oral hygiene as their arthritis makes brushing the teeth more difficult.
• Additionally, some of the drugs that patients with rheumatoid arthritis take, which include drugs that suppress the immune system, might allow harmful bacteria in the mouth to flourish.
• Furthermore, it is known that patients with rheumatoid arthritis are more likely to develop Sjögren’s syndrome, which is a disease characterized by dry mouth. Thus, patients with Sjögren’s syndrome have reduced production of the mouth’s protective saliva, which is important in fighting off bad bacteria.

However, recent research has suggested that perhaps this connection between arthritis and periodontal disease is a bit more complicated. One study showed that while patients with rheumatoid arthritis were more likely to develop periodontal disease compared to healthy people, they did not find that oral hygiene was responsible for this increased risk. Another study found that disease-modifying antirheumatic drugs (DMARDs) could also not explain the increased that periodontal disease risk.

So, what else could it be?

Another explanation for the higher incidence of periodontal disease in patients with rheumatoid arthritis could be that both these diseases share a common pathway. In fact, when researchers have looked at the mouth tissues in patients with periodontitis and the joint tissue of patients with rheumatoid arthritis, they find that there are several similarities, including the types of immune cells that are present in the tissues.

Essentially the immune cells that cause autoimmune disease are present in both types of tissue, and the compounds these cells secrete, including tumor necrosis factor, interleukin-1 and interleukin-6, are similar across patients with rheumatoid arthritis and periodontitis. Thus, the inflammatory autoimmune response in one disease can explain the development of the other.

Another explanation can be a genetic link. One study found that patients with HLA-DR4, a genetic marker that is often present in patients with rheumatoid arthritis, can also be found in 80 percent of patients with rapidly progressive periodontitis, compared to only a third of healthy controls.

So, how do we treat gum disease?

Some researchers believe that, since people with periodontitis are more likely to develop rheumatoid arthritis, treating the underlying periodontal disease will reduce this risk. In fact, one study found that among people with both rheumatoid arthritis and periodontal disease, those who underwent treatments for their gum disease had more improvement in their rheumatoid arthritis symptoms compared to patients who only received treatment for their rheumatoid arthritis.

These are some of the things you can do if you have rheumatoid arthritis:

• Schedule regular dental check-ups
• Eat healthy foods
• Brush regularly
• Floss
• Keep your arthritis under control