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News / June 9, 2009

Gum disease care ‘aids arthritis’

by Guy Hiscott

Patients who suffer from gum disease, as well as having a severe form of rheumatoid arthritis, reduced their arthritic pain, number of swollen joints and the degree of morning immobility when they tackled their oral health problems.

Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland report on this new intervention for arthritis in the Journal of Periodontology.

‘It was exciting to find that if we eliminated the infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement in the signs and symptoms of that disease,’ said Nabil Bissada DDS, chair of the department of periodontics at the dental school.

This is not the first time that gum disease and rheumatoid arthritis have been linked. According to another researcher in the study, Ali Askari MD, chair of the department of rheumatology at University Hospitals, ‘From way back, rheumatologists and other clinicians have been perplexed by the myth that gum disease may have a big role in causing systematic disease.’

He added that historically teeth were extracted or antibiotics given for treatment of rheumatoid arthritis, which actually treated the periodontitis.

Drs Askari and Bissada are part of a team of researchers that studied 40 patients with moderate to severe periodontal disease and a severe form of rheumatoid arthritis.

The study results should prompt rheumatologists to encourage their patients to be aware of the link between periodontal disease and rheumatoid arthritis, according to Dr Askari.

Both inflammatory diseases share similarities in their progression over time. In both diseases, the soft and hard tissues are destroyed from inflammation caused by toxins from bacterial infection.
One toxin from the inflamed areas, tumour necrosis factor-alpha (TNF-α), is a marker present in the blood when inflammation is present in the body. TNF-α can initiate new infections or aggravate sites where inflammation already exists.

The study’s participants were divided into four groups. Two groups of patients received a new group of anti-TNF-α drugs that block the production of TNF-α at inflamed rheumatoid arthritis sites. Two groups were not on this new medication. Half of the group of participants on the medication and half not receiving the new drug received a standard non-surgical form of periodontal treatment to clean and remove the infection from the bones and tissues in the gum areas. The other half of those studied did not receive the treatment until after completion of the study.

After receiving treatment for gum disease, improvement in rheumatoid arthritis symptoms was seen in patients who did and did not receive the anti-TNF-α medications, which block the production of TNF-α that aggravate or can cause inflammation. Patients on the TNF- α inhibitors showed even greater improvements over those not receiving the drugs.

‘I’m optimistic that someday the biologic agents that we use successfully in treatment of rheumatoid arthritis will lead to improvement of periodontitis and would be available for use and treatment of this perplexing problem,’ said Dr Askari.