Periodontal Disease and Rheumatoid Arthritis: Interconnections and Clinical Implications

 

                                                                                                          Source: Krutyhołowa et al., 2022; Front. Immunol

Rheumatoid arthritis (RA) and periodontal disease (PD) are chronic inflammatory conditions with substantial clinical and immunopathogenic overlap. Epidemiological and clinical studies consistently demonstrate a higher prevalence and severity of PD in RA patients compared to healthy controls (Rajkarnikar et al., 2013; Georgiou et al., 2004; Eriksson et al., 2019). RA patients often present with elevated gingival inflammation, greater alveolar bone loss, increased periodontal probing depths, and higher systemic inflammatory markers such as ESR and CRP, indicating shared inflammatory pathways (Patschan et al., 2020; Corrêa et al., 2019).

Microbiological Links and Autoimmunity
Subgingival microbial dysbiosis plays a critical role in bridging PD and RA. Pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans contribute to citrullination of host proteins, promoting anti-citrullinated protein antibody (ACPA) formation and systemic autoimmunity (Scher et al., 2014; Davison et al., 2021). Children with CCP-positive or RF-positive juvenile idiopathic arthritis (JIA) also exhibit oral bacterial profiles similar to PD patients, highlighting early-life risks for periodontal pathology (Delnay et al., 2017). Oral dysbiosis is correlated with increased RA disease activity and elevated local and systemic pro-inflammatory mediators, including IL-6, IL-17, IL-23, and MMP-8 (Äyräväinen et al., 2018; Corrêa et al., 2019; Patschan et al., 2020).

Impact on Quality of Life
RA and other rheumatic conditions negatively affect oral health-related quality of life (OHRQoL). Patients report xerostomia, tooth loss, and difficulty performing oral hygiene due to impaired manual dexterity, which further exacerbates periodontal inflammation (Aloyouny et al., 2022; Kiernan et al., 2023; Manzano et al., 2021). Awareness of the bidirectional influence between PD and systemic autoimmune diseases remains limited, underscoring the need for patient education and targeted oral hygiene interventions (Kocaman, 2020).

Therapeutic Implications
Periodontal treatment, particularly non-surgical therapy (scaling and root planing), reduces local oral inflammation and improves periodontal health in RA patients. Evidence suggests potential benefits on systemic inflammatory markers, psychological well-being, and OHRQoL, although effects on RA disease activity (e.g., DAS28) are inconsistent (Monsarrat et al., 2019; Posada-López et al., 2022; Tamagno et al., 2024). Systematic reviews indicate that rigorous, individualized periodontal therapy may modestly reduce RA activity, but heterogeneity in study design limits firm conclusions (Silva et al., 2022).

Anti-rheumatic medications—including NSAIDs, glucocorticoids, and DMARDs—can influence periodontal tissues, potentially modulating inflammation or microbial composition (Martu et al., 2021). Emerging research highlights inflammatory osteoclast precursors as therapeutic targets shared by RA and PD, suggesting that controlling bone resorption may benefit both conditions (Hascoët et al., 2023). Environmental risk factors, notably smoking, exacerbate periodontal and systemic inflammation, further increasing RA susceptibility (Johannsen et al., 2014).

Clinical Recommendations
The evidence supports the integration of dental evaluation and periodontal care into RA management. Routine oral health assessment, patient education, and personalized hygiene guidance are essential, particularly for patients with high disease activity, impaired dexterity, or microbial dysbiosis (Äyräväinen et al., 2023; Kiernan et al., 2023). Multidisciplinary collaboration between rheumatologists, dentists, and hygienists may improve overall health outcomes and quality of life for RA patients.

References (For an extensive reference list- click here)

Delnay, N., McNinch, N., Toth, M. Arthritis Rheumatol. 69 (2017).

Monsarrat, P., et al. Joint Bone Spine 86 (2019).

Patschan, S., et al. Odontology 108 (2020).

Äyräväinen, L., Heikkinen, A., Meurman, J. Med. Res. Arch. 11 (2023).

Aloyouny, A.Y., et al. Cureus (2022).

Silva, D.S., et al. Arthritis Care Res. 74 (2022).

Eriksson, K., et al. J. Clin. Med. 8, 5 (2019).

Davison, E., et al. Pathogens 10, 2 (2021).

Corrêa, J.D., et al. Sci. Rep. 9, 1 (2019).

Martu, M.A., et al. Pharmaceuticals 14, 12 (2021).

Hascoët, E., et al. Bone Res. 11, 1 (2023).

Johannsen, A., et al. Periodontology 2000 64, 1 (2014).