Comorbidity of rheumatoid arthritis and periodontal diseases

A growing body of evidence suggests that periodontal pathology, accompanied by oral inflammation and pathological changes in the oral microbiome, induces changes in the gut microbiome (oral-gut axis) and is involved in the pathogenesis of systemic diseases. This review focuses on the published literature, with an emphasis on the last decade, assessing whether periodontal disease, primarily periodontitis, and periodontopathic bacteria are risk factors for the development of rheumatoid arthritis. The review examines the bilateral connections between rheumatoid arthritis and periodontal pathology, and highlights the main links in this connection. Porphyromonas gingivalis and other periodontopathic bacteria may contribute to the development of inflammatory diseases by remodeling the normally benign gut microbiota into a dysbiotic one. Porphyromonas gingivalis expresses endogenous citrullinated proteins and its own unique bacterial enzyme, peptidyl arginine deminase, leading to the formation of cyclic citrullinated peptide autoantibodies and impaired immunotolerance in susceptible patients. to rheumatoid arthritis. Results from clinical studies suggest that people with periodontitis and Porphyromonas gingivalis infection are at risk of developing rheumatoid arthritis, supporting findings from experimental studies. Non-surgical periodontal treatment is likely effective in controlling rheumatoid arthritis by reducing disease activity (primarily DAS28 and ESR). These observations highlight the importance of periodontal health and the need for prevention and early treatment of periodontitis in patients with rheumatoid arthritis.