Periodontal Disease and Rheumatoid Arthritis

PERIODONTAL DISEASE AND RHEUMATOID ARTHRITIS

Rheumatoid arthritis or RA was first described clinically in 1800 in a doctoral thesis by Landre-Beauvais, a French medical student who called the condition “primary aesthetic gout”.

Sir Alfred Garrod established the distinction between rheumatoid arthritis and gout in 1859 and gave the condition its present name.

Rheumatoid arthritis is a chronic destructive inflammatory condition characterized by the accumulation and persistence of an inflammatory infiltrate in the synovial membrane that leads to synovitis and destruction of the joint architecture.


Rheumatoid arthritis is known to have a worldwide occurrence; approximately 1% of the world population is affected. The sex predilection shows female with a ratio of 3:1 with peak incidence of onset increasing in the 4th-5th decade of life.

The relation between rheumatoid arthritis and whether it is positively or negatively or not associated with the progression of existing inflammatory conditions elsewhere is still unknown although several studies have reported contradicting results regarding the relationship between periodontal disease and rheumatoid arthritis (Albander et al 1990, Kasser et al 1997).

One report indicated that the incidence of rheumatoid arthritis patients suffering from periodontitis is 3.95% compared to 1% prevalence in the general population (Mecado et al 2000).

However despite the difference noted between the epidemiological and clinical studies of the natural history of rheumatoid arthritis at least three types of disease manifestations can be observed in the rheumatoid arthritis population.

- Self limited rheumatoid arthritis: Disease commences but does not progress to cause significant damage.

- Easily controlled rheumatoid arthritis: Disease becomes established but can be controlled with first line medications.

- Progressive rheumatoid arthritis: Disease becomes established and continues to progress, use of second line medications may be of little help in arresting disease progression.




Postulated Mechanism

In both rheumatoid arthritis and periodontitis, tissue destruction is not unidirectional but an interactive process that is constantly being adjusted by the host response to inciting agents. The destruction of extra cellular matrix in both the diseases is determined by the balance of MMPs and their inhibitors.

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