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Relationship Between Periodontitis and
Rheumatoid Arthritis
P. Mark Bartold
Colgate Australian Clinical Dental Research Centre
University of Adelaide
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ENVIRONMENT
HOSTRESPONSES
GENETICS
AETIOLOGY
PERIODONTAL DISEASES
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PERIODONTAL DISEASES
ARE
ECO-GENETIC DISEASES
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May 2000, the Surgeon General the United States of America
Oral Health and general
health should notnecessarily 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 well-being.
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AtherosclerosisAtherosclerosis
MIMI
PTLBWPTLBW
Periodontitis
DiabetesDiabetes
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PERIODONTAL MEDICINE Changing paradigms for Periodontics
Systemic disease modifies periodontitis
Periodontitis may affect systemic
diseases Interrelationships between periodontitis
and other diseases
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Periodontitis Chronic inflammation
Immunoregulation imbalance
Initiating bacterial
peptides/antigens
Macrophage presence
Release of multitude of
cytokines
Genetic/environment
Rheumatoid Arthrit is Chronic inflammation
Immunoregulation imbalanc
Initiating bacterial
peptides/antigens
Macrophage presence
Release of multitude of
cytokines
Genetic/environment
MODEL FOR POSSIBLE INTERRELATIONSHIP OF
RHEUMATOID ARTHRITIS AND PERIODONTITIS
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In fact, adult periodontitis and rheumatoidarthritis have much in common, so much
so, that I have argued that they are really
the same disease.
Greenwald, RA. Adult periodontitis as a modelfor rheumatoid arthritis.
Journal of Rheumatology 26:1650-53; 1999
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What is the incidence of self-reported RA
in normal and periodontitis patients?
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HYPOTHESES
Individuals with Periodontal Disease have ahigher prevalence of RA than those withoutPeriodontitis.
Individuals with RA have a higherprevalence of advanced forms ofPeriodontitis than patients with Periodontitis
but without RA.
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PREVALENCE OF RHEUMATOID ARTHRITIS
1.00%0.66%
3.95%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
RA
Published GeneralPopulation *
General Group
Perio Group
* Arnett et al 1988* Arnett et al 1988
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RELATIVE RISK
RAPeriodontitis
Periodontitis
Relative Ris
= 4.7
Relative Ris
= 1.5
RA
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What is the incidence of periodontitis in
clinically diagnosed RA patients and howdoes this vary between different severity
indices?
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Greater tooth loss and periodontal bone lossin RA patients
Greater pocket depths in RA patients
Periodontal patients had increased incidenceof tender and swollen joints
Periodontal patients had higher HAQ scores
Periodontal patients had elevated serum CRP
levels
SUMMARY OF RESULTS
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Using standard clinical and laboratoryparameters, RA patients appeared to be more
likely to have periodontitis
A particular group of RA patients who hadmoderate to severe RA were also likely to have
severe periodontitis
CONCLUSIONS
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CONCLUSIONS
Does this represent an
underlying dysregulation of
the inflammatory responses
in these individuals?
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COMMON PATHWAYS IN
PERIODONTITIS AND RA
OSTEOCLAST ACTIVATION AND
VASCULAR DAMAGE
ROLE OF TNF-alpha Family?
(OPG, RANKL, TRAIL)
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Normal Gingiva Periodontitis Rheumatoid Arthri
OsteoProtoGerin (OPG)Decreases with increasing inflammation
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Normal Gingiva Periodontitis Rheumatoid Arthri
ReceptorActivator ofNF Kappa L igand B
(RANKL)Increases with increasing inflammation
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Normal Gingiva Periodontitis Rheumatoid Arthr
TNF-RelatedApoptosis Inducing L igand
(TRAIL)Increases in connective tissue with inflammation
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Working Model
OPG decreases leading todecreased vascular protection. With
an increase in RANKL and TRAIL not
only is vascular damage possible butsignificant activation of osteoclasts
may result.
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Of course,
This is only one small piece in thepuzzle, but
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Evidence is accruing to supportthe hypothesis that Periodontitis
and Rheumatoid Arthritis areinterrelated diseases
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