Impact of Oral Health on Rheumatoid Arthritis
Main Article Content
Abstract
This is a narrative review describing how oral infections and diseases associate with rheumatoid arthritis. From the voluminous oral microbiom, bacteria can get access to circulation through inflamed periodontal tissue, oral mucosa, and carious teeth. This results in upregulation of a number of chemokines and cytokines that often cause chronic, subclinical systemic inflammation with consequent organ pathology. The periodontal pathogen Porphyromonas gingivalis was observed to cause citrullination of proteins that play a role in the development of arthritis by generating of specific autoantibodies such as anti-citrullinated peptide antibody. These migrate and form immune complexes at the synovial membrane of joints. In general, patients with rheumatoid arthritis should have a healthy mouth. Dry mouth is a symptom seen among many patients with rheumatic diseases, also rheumatoid arthritis. Because saliva is one of the principal defense factors of the mouth, hyposalivation renders the patient liable to oral diseases. Consequently, the patients must drink enough daily and use saliva substitutes when necessary, and, above all, maintain good oral hygiene daily. In rheumatoid arthritis, manual dexterity may be impaired, however, causing cleaning the teeth difficult. Hence, patients with rheumatic diseases like rheumatoid arthritis need counseling and individual oral health care instructions by oral health care professionals for implementation at home. An electric toothbrush should be recommended. Regular oral health examinations by dentists are needed more often than among the healthy.
Keywords:
Rheumatoid arthritis, Oral health, Dry mouth, Periodontitis, Porphyromonas gingivalis, ACPA
Article Details
How to Cite
ÄYRÄVÄINEN, Leena; HEIKKINEN, Anna Maria; MEURMAN, Jukka H.
Impact of Oral Health on Rheumatoid Arthritis.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4644>. Date accessed: 17 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4644.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Brito-Zerón P, Baldini C, Bootsma H, Bowman SJ, Jonsson R, Mariette X, Sivils K, Theander E, Tzioufas A, Ramos-Casals M. Sjögren syndrome. Nat Rev Dis Primers. 2016; 2:16047. doi: 10.1038/nrdp.2016.47.
4. Helenius LM, Meurman JH, Helenius I, Kari K, Hietanen J, Suuronen R, Hallikainen D, Kautiainen H, Leirisalo-Repo M, Lindqvist C. Oral and salivary parameters in patients with rheumatic diseases. Acta Odontol Scand. 2005; 63:284-93. doi: 10.1080/000163505100 20043.
5. Berman N , Vivino F, Baker J, Dunham J, Pinto A. Risk factors for caries development in primary Sjogren syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128:117-22. doi: 10.1016/j.oooo.2019.04.011.
6. Nathan CO, Asarkar AA, Entezami P, Corry J, Strojan P, Poorten VV, Makitie A, Eisbruch A, Robbins KT, Smee R, St John M, Chiesa-Estomba C, Winter SC, Beitler JJ, Ferlito A. Current management of xerostomia in head and neck cancer patients. Am J Otolaryngol. 2023; 44:103867. doi: 10.1016/j.amjoto.2023. 103867.
7. Krutyhołowa A, Strzelec K, Dziedzic A, Bereta GP, Łazarz-Bartyzel K, Potempa J, Gawron K. Host and bacterial factors linking periodontitis and rheumatoid arthritis. Front Immunol. 2022; 13:980805. doi: 10.3389/ fimmu.2022.980805.
8. Li Y, Guo R, Oduro PK, Sun T, Chen H, Yi Y, Zeng W, Wang Q, Leng L, Yang L, Zhang J. The Relationship Between Porphyromonas Gingivalis and Rheumatoid Arthritis: A Meta-Analysis. Front Cell Infect Microbiol. 2022; 12:956417. doi: 10.3389/fcimb.2022.956417.
9. Ahola K, Saarinen A, Kuuliala A, Leirisalo-Repo M, Murtomaa H, Meurman JH. Impact of rheumatic diseases on oral health and quality of life. Oral Dis. 2015; 21:342-8. doi: 10.1111/odi.12285.
10. Kreher D, Ernst BLV, Ziebolz D, Haak R, Ebert T, Schmalz G. Dental Caries in Adult Patients with Rheumatoid Arthritis-A Systematic Review. J Clin Med 2023; 12:4128. doi: 10 3390/jcm12124128.
11. World Health Organization Global Oral Health Status 2022. https://www.who.int/news-room/fact-sheets/detail/oral-health
12. Feres M, Teles F, Teles R, Figueiredo LC, Faveri M. The subgingival periodontal microbiota of the aging mouth. Periodontol 2000. 2016; 72:30-53. doi: 10.1111/prd. 12136.
13. Martinez-Martinez RE, Domínguez-Pérez RA, Sancho-Mata J, Abud-Mendoza C, Ayala-Herrera JL, Popoca-Hernandez EA. The frequency and severity of dental caries, and counts of cariogenic bacteria in rheumatoid arthritis patients. Dent Med Probl. 2019; 56:137-142. doi: 10.17219/dmp/105340.
14. Silvestre-Rangil J, Bagán L, Silvestre FJ, Bagán JV. Oral manifestations of rheumatoid arthritis. A cross-sectional study of 73 patients. Clin Oral Investig. 2016; 20:2575-80. doi: 10.1007/s00784-016-1745-z.
15. Äyräväinen L, Heikkinen AM, Kuuliala A, Ahola K, Koivuniemi R, Peltola J, Suomalainen A, Moilanen E, Hämäläinen M, Laasonen L, Meurman JH, Leirisalo-Repo M. Activity of rheumatoid arthritis correlates with oral inflammatory burden. Rheumatol Int. 2018; 38:1661-1669. doi: 10.1007/s00296-018-4108-z.
16. Kaufman E, Lamster IB. Analysis of saliva for periodontal diagnosis--a review. J Clin Periodontol. 2000; 27:453-65. doi: 10.1034/j. 1600-051x.2000.027007453. x.
17. Miller CS, King CP Jr, Langub MC, Kryscio RJ, Thomas MV. Salivary biomarkers of existing periodontal disease: a cross-sectional study. J Am Dent Assoc. 2006; 137:322-9. doi: 10.14219/jada.archive.2006.0181.
18. Jørgensen KT, Wiik A, Pedersen M, Hedegaard CJ, Vestergaard BF, Gislefoss RE, Kvien TK, Wohlfahrt J, Bendtzen K, Frisch M. Cytokines, autoantibodies and viral antibodies in premorbid and postdiagnostic sera from patients with rheumatoid arthritis: case-control study nested in a cohort of Norwegian blood donors. Ann Rheum Dis. 2008; 67:860–6. doi: 10.1136/ard.2007. 073825.
19. Äyräväinen L, Leirisalo-Repo M, Kuuliala A, et al. Periodontitis in early and chronic rheumatoid arthritis: a prospective follow-up study in Finnish population. BMJ Open. 2017; 7: e011916. doi: 10.1136/bmjopen-2016-011916.
20. Payne JB, Golub LM, Thiele GM, Mikuls TR. The Link Between Periodontitis and Rheumatoid Arthritis: A Periodontist's Perspective. Curr Oral Health Rep. 2015; 2:20-29. doi: 10.1007/s40496-014-0040-9.
21. Kaur S, Bright R, Proudman SM, Bartold PM. Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis. Semin Arthritis Rheum 2014; doi: 10.1016/j.semarthrit.2014.04.009.
22. de Molon RS, Rossa C Jr, Thurlings RM, Cirelli JA, Koenders MI. Linkage of periodontitis and rheumatoid arthritis: current evidence and potential biological interactions. IJMS. 2019; 20:4541-4635. doi: 10.3390/ijms20184541.
23. de Pablo P, Chapple ILC, Buckley CD, Dietrich T. Periodontitis in systemic rheumatic diseases. Nat Rev Rheumatol. 2009; 5:218-224. doi: 10.1038/nrrheum.2009.28.
24. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011; 365:2205-2219. doi: 10.1056/NEJMra1004965.
25. Nielen MMJ, van Schaardenburg D, Reesink HW, et al. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum. 2004; 50:380-386. doi: 10.1002/art.20018.
26. van de Sande MGH, van de Sande MGH, de Hair MJH, et al. Different stages of rheumatoid arthritis: features of the synovium in the preclinical phase. Ann Rheum Dis. 2011; 70:772-777. doi: 10.1136/ard.2010.139527.
27. Brink M, Hansson M, Mathsson L, et al. Multiplex analyses of antibodies against citrullinated peptides in individuals prior to development of rheumatoid arthritis. Arthritis Rheum. 2013; 65:899-910. doi: 10.1002/ art.37835.
28. Gully N, Bright R, Marino V, et al. Porphyromonas gingivalis peptidylarginine deiminase, a key contributor in the pathogenesis of experimental periodontal disease and experimental arthritis. Yilmaz Ö, editor. PLoS One. 2014; 9: e100838. doi: 10.1371/journal.pone.0100838.
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