Rheumatoid arthritis and periodontal disease do not seem like related conditions on the surface. One is an autoimmune joint disorder and the other is a dental infection. But the research connecting them is among the more compelling bidirectional disease associations in medicine.
The Porphyromonas gingivalis and rheumatoid arthritis connection
The most mechanistically specific connection involves Porphyromonas gingivalis and its unique enzymatic capability. P. gingivalis is the only known bacterium that produces the enzyme peptidylarginine deiminase. This enzyme performs citrullination which is converting the amino acid arginine to citrulline in proteins. Citrullinated proteins are the primary antigens targeted by the anti-citrullinated protein antibodies that are the diagnostic hallmark of seropositive rheumatoid arthritis. The remarkable implication is that P. gingivalis may be generating the citrullinated protein antigens that trigger the autoimmune response in rheumatoid arthritis through a molecular mimicry mechanism. Multiple epidemiological studies have found that people with rheumatoid arthritis have significantly higher rates of periodontitis than controls.
What periodontal treatment does for rheumatoid arthritis
Several clinical trials have found that successful periodontal treatment is associated with improvements in rheumatoid arthritis disease activity measures. A 2009 study found significant reductions in DAS28 which is a composite rheumatoid arthritis disease activity score after periodontal treatment. A 2014 meta-analysis found periodontal treatment significantly reduced CRP and erythrocyte sedimentation rate which are standard rheumatoid arthritis inflammatory markers. The effect sizes are modest but consistent.
Practical considerations
For people with rheumatoid arthritis: inform your dentist and rheumatologist both of your conditions. Some rheumatoid arthritis medications particularly methotrexate affect the oral mucosa and wound healing. DMARDs may modify immune responses that affect susceptibility to oral infection. Oral dryness from some medications is common. Maintaining periodontal health may have actual benefits for rheumatoid arthritis disease control. For gum health support our dental supplement guide covers the nutritional approaches with relevant evidence.
Educational content. Not medical advice. Coordinate care between your rheumatologist and your dental team.
