People with rheumatoid arthritis may be at increased risk for periodontal disease, according to researchers from the Johns Hopkins University School of Medicine.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by rheumatoid arthritis, inflammation can develop in other organs as well. An estimated 1.3 million Americans have rheumatoid arthritis, and the disease typically affects women twice as often as men.

Some studies have shown links between rheumatoid arthritis and periodontal disease, a gum disease characterized by inflammation that leads to separation of the teeth from the gums, loss of bony support, and possible tooth loss; however, many of these studies have lacked rheumatoid arthritis specific information.

The researchers evaluated the prevalence of periodontal disease, and other aspects of oral health, in 153 patients with rheumatoid arthritis who were already enrolled in a cardiovascular disease study. Sixty-six percent of the patients were female, ranged in age from 45 to 84 years, were primarily Caucasian, and had, on average, suffered from rheumatoid arthritis for 11 years.

The researchers administered oral health questionnaires that assessed their dental histories, oral hygiene practices, tooth loss, mouth dryness, and periodontal disease status of each patient. Periodontal-specific questions included past diagnosis and treatment of periodontal disease, as well as self-reported gum recession due to gingivitis and bleeding and swelling of the gums.

By using established rheumatoid arthritis criteria, researchers looked at the associations between the disease and periodontal symptoms and estimated the prevalence of periodontal disease in the patients taking into consideration socio-demographic factors, lifestyle, and oral hygiene, as well as the presence of other diseases.

Eighty-two percent of the patients reported periodontal symptoms, including a history of the disease, gum recession, swollen gums and gum bleeding. In further analysis, researchers found that the presence of periodontal disease was significantly associated with a patient’s rheumatoid arthritis disease activity score, or DAS as it is commonly called, and with rheumatoid nodules – leading researchers to believe that periodontal disease is independently associated with rheumatoid arthritis disease activity.

“These findings, along with prior studies and our additional preliminary data showing a high prevalence of moderate to severe periodontal disease in rheumatoid arthritis patients based on comprehensive oral examinations, strongly suggest an association between these two inflammatory diseases. We are now conducting a number of additional studies to better understand the pathobiologic mechanisms that may explain these associations,” notes Clifton O. Bingham III, lead investigator of the study. “It is notable that treatment of periodontal disease leads to improvement of other
systemic conditions including diabetes, and may even lower cardiovascular risk. Thus it is possible that increased attention to oral health and treatment of periodontal disease may improve outcomes for patients with rheumatoid arthritis.”
References:
1. C.O. Bingham,, et al. Periodontal Disease Symptoms are Independently Associated with Rheumatoid Arthritis Disease Activity. American College of Rheumatology.