By Ed Susman

PHILADELPHIA, PA – Researchers suggested that individuals with moderate to severe adult periodontitis have more than eight times the risk of rheumatoid arthritis when compared with other non-smokers who have healthy gums.

Scientists examining the records compiled for the Atherosclerosis Risk in Communities Study (ARIC) determined that if a person had moderate to severe periodontal disease – 10% or more of their teeth having attachment loss – then their risk of rheumatoid arthritis was 2.6 times that of individuals with healthy gums.

“Among non-smokers moderate to severe periodontitis is associated with a more markedly increased risk for developing rheumatoid arthritis,” Jerry A. Molitor, MD, PhD, associate professor of rheumatology and autoimmune disease, University of Minnesota Minneapolis, said here at the annual scientific session of the American College of Rheumatology.

Dr. Molitor and colleagues identified 33 individuals in the ARIC study who developed rheumatoid arthritis during the eight-year period of follow-up after an initial periodontal examination. The study included 15,792 individuals of whom 6,616 were evaluated for periodontal disease in 1996 and 1998 – actually as part of a study looking at periodontal disease and its possible link to heart disease. This group was followed for as long as eight years by checking their hospital discharge records. The participants were 45-64 years of age at the start of the study.

Jerry Molitor, MD

Of those 33 individuals, 6 had no periodontal disease or mild disease – defined as less than 10% of teeth having attachment loss, while 27 cases occurred in patients with moderate to severe periodontal disease.

Dr. Molitor suggested that “moderate to severe periodontitis, a chronic infectious disease of the gums leading to loosening of the teeth, may also increase the risk of developing rheumatoid arthritis.”

“Furthermore, among those who smoke, moderate to severe periodontitis may increase the risk of developing a specific type of antibodies associated with more severe, damaging rheumatoid arthritis,” he said. “These studies point out the importance of further studies into how periodontitis may predispose to rheumatoid arthritis, and the possible value of dental care in prevention of rheumatoid arthritis.”

He said that people with periodontitis were also more likely to develop higher levels of the anti cyclic citrullated antibody, which has been associated with more severe, damaging rheumatoid arthritis.

“There are huge gaps in our knowledge regarding dental hygiene and the links between periodontal disease and rheumatoid arthritis,” said Daniel Lewis, MD, co-director of the Deakin University Integrative Health Research Unit, Melbourne, Australia.

Dr. Lewis, who also has a private practice rheumatology practice, said studies have shown links between gum tissue and other tissues impacted by rheumatoid arthritis

“This is an exploratory study with a cohort that was never intended to look at this question of linking periodontal disease to rheumatoid arthritis,” Dr. Molitor said. “I think this needs to be confirmed in additional ways. However, I think our study strengthens this idea.”

“I think this has significant implications for patients if this is correct,” he said. “If there is rheumatoid arthritis in the family of a patient, we should be telling people to be very careful of their dental care.”

–10-21-2009