The Link Between Rheumatoid Arthritis and Dental Health

Research into oral health and RA has been ongoing for decades. “For some reason, rheumatoid arthritis and dental health—specifically something we call periodontal disease—are linked,” says Maximilian Konig, M.D., a rheumatologist at Johns Hopkins Medicine in Baltimore, MD. In fact, a study from Johns Hopkins Arthritis Center found that out of 100 RA patients, 70% of them had at least moderate gum disease. That rate is significantly higher than the general population, where only 35% of people have gum disease.

Researchers have suspected a connection between rheumatoid arthritis and gum disease for nearly a century, but only recently has the picture become clearer. The current thinking is that certain bacteria in your mouth that are known to cause periodontal disease may also act as a trigger for RA, says Dr. Konig. Essentially, your oral health might play a role in either initiating joint pain symptoms or exacerbating them. “Nothing is 100 percent certain, we are still learning,” he says, but it is likely that it’s a two-way street between oral health and arthritis.

As it turns out, the same bacteria may be responsible for inflammation in both dental disease and RA. In 2016, researchers at Johns Hopkins identified a type of bacteria called Aggregatibacter actinomycetemcomitans (try saying that three times fast!) as the source for chronic gum inflammation that leads to periodontal disease. Basically, the bacteria triggers the production of modified proteins that the immune system attacks as foreign. Scientists believe the inflammatory response to the bacteria may spread throughout the body, triggering RA symptoms.

While the correlation between gum disease and RA is becoming increasingly accepted in the medical community, it’s still just a theory. “We know that oral flora can have an impact on rheumatoid arthritis, but not every patient has an A to B connection,” says Jonathan Samuels, M.D., a rheumatologist at New York University Langone Health. In other words, if you have RA, you might never develop gum disease, and vice versa. Also, because RA symptoms can take years to appear, it’s possible someone could have had periodontal disease a decade before an RA diagnosis, and not realize the connection.

Scientists know that gut bacteria can affect the immune system and some research shows a potential connection between the so-called gut microbiome and chronic inflammation that accompanies RA. Could this be the same bacteria that is involved in periodontal disease? Researchers are working to find out. “Ideally, you would be able to say, ‘We think this bacterium and this bacterium are the perpetrators,’” says Dr. Konig. “We can’t do that yet.”

If certain types of oral bacteria do cause RA, it wouldn’t be the first time an autoimmune disease has been linked to a bacterial trigger. Previous studies have revealed that if you have a family history or genetic marker for conditions like lupus, for instance, you may be more susceptible to bacteria that kick off the inflammatory process. Furthermore, trials of antibiotics have shown some promise in treating autoimmune diseases.

Ideally, once specific bacteria are identified as triggers for gum disease and rheumatoid arthritis, doctors may be able identify people at risk for RA based on their teeth and treat them before symptoms even occur. “Interfering with oral health might actually improve overall health in terms of RA,” Dr. Konig explains. “If you were to start aggressive periodontal treatment to get rid of the bacteria, maybe you could prevent them from developing the other disease.” Keeping gums healthy plus preventing the progression of joint pain: Now that’s getting your money’s worth!

Dentists are an important resource for RA folks. If the research on oral bacteria proves correct, a healthy mouth could minimize progression of your arthritis symptoms. “Everyone with RA should have a dentist that is also able to evaluate their overall oral health and the presence of periodontal disease,” Dr. Konig says. And if you have periodontal disease, it’s worth getting a periodontist to guide you through treatment: deep cleaning, medication, and surgery if necessary.

Everyone should get their teeth cleaned at least once per year but if rheumatoid arthritis runs in your family, you might want to go more often. “It’s not unreasonable for people to ask their dentist of periodontist about the overall state of their oral health and use that information to guide their decisions about RA,” Dr. Konig says. An increase in gum inflammation could be an early warning sign of an RA flare and eliminating bad oral bacteria may keep RA symptoms at bay. Bottom line: Take care of your teeth—it just might help your aching joints.