Acute-phase Inflammatory Response to Periodontal Disease in the US Population Periodontal infection as a possible severity factor for rheumatoid arthritis. Rheumatoid factor (RF) distribution in periodontal disease
Moderate elevation of serum C-reactive protein ( CRP ) is a risk factor for cardiovascular disease among apparently healthy individuals , although factors that create this inflammatory response in the absence of systemic illness have not been clarified . This study aim ed to : ( 1 ) evaluate associations among periodontal disease , established risk factors for elevated CRP , and CRP levels within the US population ; and ( 2 ) determine whether total tooth loss is associated with reduced CRP . Data were obtained from the third National Health and Nutrition Examination Survey . A r and om sample of the US population was interviewed in their homes and examined at mobile examination centers .  CRP  was quantified from peripheral blood sample s and analyzed as a continuous variable and as the prevalence of elevated CRP ( ≥ 10 mg/L ) . Some 12,949 people aged 18 + years who had periodontal examinations and an additional 1817 edentulous people aged 18 + years were included in the analysis . Dentate people with extensive periodontal disease ( > 10 % of sites with periodontal pockets 4 + mm ) had an increase of approximately one-third in mean CRP and a doubling in prevalence of elevated CRP compared with periodontally healthy people . Raised CRP levels among people with extensive periodontal disease persisted in multivariate analyses ( P < 0.01 ) , with established risk factors for elevated CRP ( diabetes , arthritis , emphysema , smoking , and anti-inflammatory medications ) and sociodemographic factors controlled for . However , CRP levels were similarly raised in edentulous people . Furthermore , the established risk factors for elevated CRP modified relationships between oral status and CRP levels . Periodontal disease and edentulism were associated with systemic inflammatory response in the US population , most notably among people who had no established risk factors for elevated CRP OBJECTIVE Clinical effects of periodontal treatment on biochemical and clinical markers of disease severity in rheumatoid arthritis ( RA ) patients with periodontal disease were evaluated . METHODS Forty-two patients were assigned to two groups , G1 ( n=16 ) and G2 ( n=26 ) . G1 patients were su bmi tted to oral hygiene instruction and professional tooth cleaning and G2 patients additionally had full-mouth scaling and root planing ( SRP ) . Clinical periodontal measurements were obtained at baseline and 3 months after periodontal treatment . A Health Assessment Question naire ( HAQ ) was used to evaluate their performance on daily living . Rheumatoid factor ( RF ) , erythrocyte sedimentation rate ( ESR ) and drug therapy were assessed . RESULTS Both groups presented a full-mouth improvement in all periodontal clinical parameters ( p<0.05 ) , with the exception of clinical attachment level ( CAL ) and probing pocket depth ( PPD ) > 6 mm for G1 . G2 showed greater mean reductions on PPD > 4 mm than G1 ( p<0.001 ) . HAQ analyses showed a reduction on the degree of disability of G2 , but not statistically significant . ESR was significantly reduced for G2 after SRP although RF did not show statistical reductions . CONCLUSION The data suggest that periodontal treatment with SRP might have an effect on the ESR reduction This study investigated the occurrence of an autoantibody , IgM rheumatoid factor , that may result from the chronic inflammation noted in periodontal disease and rheumatoid arthritis . In order to detect IgM-RF , a biotin-avidin ELISA was developed . This assay was found to be sensitive and accurate by testing a rheumatoid arthritis population . The characteristics of this rheumatoid arthritis group were further determined , such that the total serum immunoglobulin concentrations were slightly elevated although within the normal range for IgM , IgG , and IgA ; IgG antibody levels were elevated against oral microorganisms of the genusCapnocytophaga , while elevated IgM antibody levels were noted toBacteroides species . In a population of 260 subjects of which 171 were periodontal disease patients , 16 of 171 ( 9.4 % ) were seropositive for IgM-RF , of which the predominant disease types were advanced destructive periodontitis and adult periodontitis . For comparison , a r and om population of seronegative periodontal disease patients was constructed that was matched for sex and approximate age to the seropositive group . The total immunoglobulin levels of the two groups were not significantly different and the means of both were slightly lower than the rheumatoid arthritis group . When the antibody profiles of the two periodontal disease population s were compared it became evident that the RF-positive group showed IgM and IgG antibody that was significantly elevated toCapnocytophaga species and F. nucleatum . Therefore , the chronic inflammation associated with periodontitis appears to increase significantly the formation of IgM-RF ; however , there does appear to be a relationship between IgM-RF and elevated antibody to selected oral microorganisms
This systematic review considers the evidence available for a relationship between periodontal disease and rheumatoid arthritis .