Relationship Between Periodontitis and

Rheumatoid Arthritis
P. Mark Bartold
Colgate Australian Clinical Dental Research Centre
University of Adelaide

PERIODONTAL DISEASES
ENVIRONMENT
HOST
RESPONSES

AETIOLOGY

GENETICS

PERIODONTAL DISEASES
ARE
ECO-GENETIC DISEASES

Oral Health and general

health should not
necessarily be dissociated
as in the past.
In the interests of an
holistic approach to patient
care oral health must be
considered as a critical
issue for general wellbeing.
May 2000, the Surgeon General of
the United States of America

Atherosclerosis
MI

Diabetes
Periodontitis
PTLBW

PERIODONTAL MEDICINE

Changing paradigms for Periodontics

Systemic disease modifies periodontitis
Periodontitis may affect systemic
diseases
Interrelationships between periodontitis
and other diseases

MODEL FOR POSSIBLE INTERRELATIONSHIP OF

RHEUMATOID ARTHRITIS AND PERIODONTITIS

Periodontitis

Rheumatoid Arthritis

Chronic inflammation

Chronic inflammation

Immunoregulation imbalance

Immunoregulation imbalance

Initiating bacterial
peptides/antigens

Initiating bacterial
peptides/antigens

Macrophage presence

Macrophage presence

Release of multitude of
cytokines

Release of multitude of
cytokines

Genetic/environment

Genetic/environment

In fact, adult periodontitis and rheumatoid

arthritis have much in common, so much
so, that I have argued that they are really
the same disease.
Greenwald, RA. Adult periodontitis as a model
for rheumatoid arthritis.
Journal of Rheumatology 26:1650-53; 1999

What is the incidence of self-reported RA

in normal and periodontitis patients?

HYPOTHESES
Individuals with Periodontal Disease have a
higher prevalence of RA than those without
Periodontitis.
Individuals with RA have a higher
prevalence of advanced forms of
Periodontitis than patients with Periodontitis
but without RA.

PREVALENCE OF RHEUMATOID ARTHRITIS

5.00%
4.00%
3.00%

Published General
Population *
General Group

2.00%

Perio Group

3.95%

1.00%
1.00%
0.66%

0.00%
RA

* Arnett et al 1988

RELATIVE RISK

Relative Risk
= 4.7
RA

Periodontitis
Relative Risk
= 1.5

Periodontitis

RA

What is the incidence of periodontitis in

clinically diagnosed RA patients and how
does this vary between different severity
indices?

SUMMARY OF RESULTS
Greater tooth loss and periodontal bone loss
in RA patients
Greater pocket depths in RA patients
Periodontal patients had increased incidence
of tender and swollen joints
Periodontal patients had higher HAQ scores
Periodontal patients had elevated serum CRP
levels

CONCLUSIONS
Using standard clinical and laboratory

parameters, RA patients appeared to be more

likely to have periodontitis

A particular group of RA patients who had

moderate to severe RA were also likely to have
severe periodontitis

CONCLUSIONS

Does this represent an

underlying dysregulation of
the inflammatory responses
in these individuals?

COMMON PATHWAYS IN
PERIODONTITIS AND RA
OSTEOCLAST ACTIVATION AND
VASCULAR DAMAGE
ROLE OF TNF-alpha Family?
(OPG, RANKL, TRAIL)

Normal Gingiva

Periodontitis

Rheumatoid Arthritis

OsteoProtoGerin (OPG)
Decreases with increasing inflammation

Normal Gingiva

Periodontitis

Rheumatoid Arthritis

Receptor Activator of NF Kappa Ligand B

(RANKL)
Increases with increasing inflammation

Normal Gingiva

Periodontitis

Rheumatoid Arthritis

TNF-Related Apoptosis Inducing Ligand

(TRAIL)
Increases in connective tissue with inflammation

Working Model
OPG decreases leading to
decreased vascular protection. With
an increase in RANKL and TRAIL not
only is vascular damage possible but
significant activation of osteoclasts
may result.

Of course,

This is only one small piece in the

puzzle, but

Evidence is accruing to support

the hypothesis that Periodontitis
and Rheumatoid Arthritis are
interrelated diseases