Periodontal disease in RA

Question 1

What are periodontal diseases?

Answer 1

They affect gums e.g. gingivitis (inflammation of the gums) or periodontitis (chronic inflammatory disease characterised by the loss of ligament and bone loss)

Question 2

What does periodontitis lead to?

Answer 2

Tooth loss

Question 3

What is the connection between periodontitis and RA?

Answer 3

Areas of ulceration in periodontitis can be colonised by billions of pathogens and these pathogens can lead to citrullination of proteins (De Pablo 2009). People with periodontitis are more likely to have RA (Fuggle 2016)

Question 4

How can pathogens lead to citrullination of proteins?

Answer 4

There are different mechanisms by which pathogens can cause citrullination.
- Pg has PPADs enzymes which can cause citrullination
- Aa secretes leukotoxin A which induces neutrophil death mediated by host’s PADs enzymes
It is hypothesised that it leads to generation of anti-citrullinated antibodies

Question 5

Treatment of periodontitis effects on RA?

Answer 5

There were few studies done checking the effect of periodontitis treatment on patients with RA and periodontitis. These studies showed beneficial effects on disease activity score improvement.