Rheumatoid Arthritis and Periodontitis – Plausible Inflammatory Link
Bhuvaneswari Birla Bose1 and Bagavad Gita21Department of Periodontics, Tagore Dental College and Hospital, Chennai, India 2Department of Periodontics, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai-600100
Abstract: An association between oral disease/periodontitis and rheumatoid arthritis (RA) has been considered for more than a century. RA is considered as an autoimmune disease whereas periodontitis has an infectious etiology with a complex inflammatory response. Inspite of the controversial etiology, both diseases are chronic and may present with bursts of disease activity. Genetic factors are driving the host responses in both RA and periodontitis. The inflammatory events are regulated by Tumor necrosis factor - a, a proinflammatory cytokine, in both RA and periodontitis. Porphyromonas gingivalis is a common pathogen in periodontal infection. P. gingivalis has also been identified in synovial fluid. The specific abilities of P. gingivalis to citrullinate host peptides by proteolytic cleavage at Arg-X peptide bonds by arginine gingipains can induce autoimmune responses in RA through development of anticyclic citrullinated peptide antibodies. In addition, P. gingivalis carries heat shock proteins (HSPs) that may also trigger autoimmune responses in subjects with RA. Data suggest that periodontal therapies combined with routine RA treatments further improve RA status. This review enlightens the link between periodontitis and rheumatoid arthritis.
Keywords: rheumatoid arthritis; periodontitis; bacteria; inflammation; Porphyromonas gingivalis; citrullination; genetics Back to TOC