Circular link between gum disease and rheumatoid arthritis revealed in new study

From birmingham.ac.uk

Association between periodontitis and rheumatoid arthritis is long established, but which comes first has long been debated by scientists 

Researchers have uncovered compelling evidence of a two-way relationship between rheumatoid arthritis (RA) and periodontitis (gum disease), showing that treating gum disease can significantly reduce inflammation and improve RA symptoms for patients.

The study, published in the Journal of Clinical Periodontology, examined how microbial imbalances in the mouth – known as dysbiosis – contribute to systemic inflammation in RA patients.

Led by University of Birmingham researchers from the Periodontal Research Group and the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, the University of Michigan and Queen Mary University of London, the study investigated the interactions between oral bacteria and immune molecules, and correlated the molecular interactions with clinical outcomes in 159 participants, including RA patients with and without gum disease, individuals with gum disease alone, and healthy controls.

"We found that treating gum disease through intensive periodontal therapy broke this cycle: it improved RA activity scores, reduced antibodies to oral pathogens, and re-established a balanced interaction between oral microbes and the immune system within three months."

Professor Iain Chapple, University of Birmingham

Key Findings

• RA patients exhibited distinct oral microbiomes, even before gum disease developed. These microbial communities were richer and more diverse than those in healthy individuals and formed dense interaction networks.

• Certain bacteria, such as Cryptobacterium curtum and Prevotella species, were strongly associated with RA and correlated with pro-inflammatory cytokines.

• RA patients had higher levels of antibodies against oral pathogens, particularly Porphyromonas gingivalis, a bacterium linked to protein citrullination – a process implicated in RA autoimmunity.

• Severity of gum disease strongly correlated with RA activity scores, including joint swelling and pain.

Professor Iain Chapple, co-lead for the oral, intestinal and systemic health theme of Birmingham’s NIHR Biomedical Research Centre, said:

“These findings are extremely significant, as it’s the first time that rheumatoid arthritis (RA) and periodontitis (gum disease) have been shown to be linked in a circular relationship, creating a vicious cycle of inflammation. RA-driven systemic inflammation disrupts the oral microbiome, fostering harmful bacteria that trigger gum disease; in turn, these bacteria worsen oral inflammation and impair immune responses, which in turn fuel RA by generating antibodies linked to joint damage.

“We found that treating gum disease through intensive periodontal therapy broke this cycle: it improved RA activity scores, reduced antibodies to oral pathogens, and re-established a balanced interaction between oral microbes and the immune system within three months.”

Professor Purnima Kumar, senior author and Chair of the Department of Periodontics and Oral Medicine at the University of Michigan said: “Oral health is the result of an evolutionary balance between the resident oral bacteria and the mucosal immune system. We discovered that RA disrupts this microbial-mucosal interaction, leading to a self-perpetuating cycle of inflammation and dysbiosis.

“When we treat periodontitis, we reboot these molecular interaction networks, thereby moving the oral ecosystem towards balance and disrupting the cycle of systemic inflammation. This is yet another reminder that the body functions as an integrated biological system, and therefore, therapeutic interventions need to be integrated to be effective.

The importance of integrated care

RA is a leading cause of disability in the UK, affecting around 1% of the population; whilst gum disease is widespread and often overlooked in systemic health management. This research highlights the importance of integrated care to improve the overall health and wellbeing of patients navigating inflammation.

The study also evaluated the impact of intensive non-surgical periodontal therapy – professional cleaning combined with oral hygiene coaching – compared to oral hygiene advice alone:

• Periodontal treatment reduced gum inflammation and restored balance between oral bacteria and the immune system.

• Levels of inflammatory cytokines in gum fluid dropped significantly after treatment.

• Circulating antibodies to oral bacteria decreased, and RA clinical scores improved, including reductions in joint tenderness and disease activity.

• Network analysis showed that therapy “re-wired” immune–microbial interactions, strengthening the body’s ability to control harmful bacteria.

Dr Isabel Lopez-Oliva, a NIHR Academic Clinical Lecturer from Queen Mary University of London and a co-author of the study, added: “We’ve demonstrated that periodontal therapy offers measurable benefits for RA patients, even when the disease is established. This opens the door to new strategies for reducing inflammation and improving quality of life.”

The research was supported by the National Institute of Dental and Craniofacial Research and delivered through the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), which brings together multidisciplinary research teams specialising in a wide range of inflammatory conditions – including inflammatory arthritis and periodontitis. The study builds on previous work from the OPERA trial, which first suggested that periodontal treatment could improve RA outcomes.

https://www.birmingham.ac.uk/news/2026/circular-link-between-gum-disease-and-rheumatoid-arthritis-revealed-in-new-study

Gum disease may lie at the root of some arthritis flare-ups

From eurekalert.org

It’s a well-documented medical mystery: Patients with gum disease are less likely to respond to rheumatoid arthritis treatments. But new research may help explain this link between gum disease and an otherwise disparate condition. The findings, published in Science Translational Medicine, suggests that breaches in damaged gums allow bacteria in the mouth to seep into the bloodstream, activating an immune response that ultimately pivots to target the body’s own proteins and causes arthritis flare-ups.

“If oral bacteria are getting in and repeatedly triggering immune responses relevant to rheumatoid arthritis, that could make it harder to treat,” says Dana Orange, a professor of clinical investigation in the laboratory of Robert B. Darnell at The Rockefeller University. “When doctors encounter arthritis patients who do not respond to treatment, it would be worth it to make sure they aren’t missing an underlying gum disease, which is quite treatable.”

The Darnell lab had been following a small group of arthritis patients over the course of several years, collecting weekly blood samples and looking for changes in gene expression to help explain why painful flare-ups occur, when they noticed a surprising trend. Two of their patients, who had moderate to severe periodontal disease, had repeated episodes of oral bacteria in their bloodstreams, even when they weren’t having dental work.

Orange knew that rheumatoid arthritis patients generally have autoantibodies in their bloodstream (rheumatoid arthritis is an auto-immune disease, wherein antibodies attack the body’s own proteins and peptides). In many cases, autoantibodies take specific aim at proteins bearing the signs of citrullination, a process by which one amino acid in the protein is converted into a different one.

Upon further examination, the team discovered that the oral bacteria they detected in the blood are also citrullinated in the mouth, much like the proteins targeted by autoantibodies in arthritis. They then demonstrated that the same autoantibodies that take potshots at the body’s citrullinated proteins activate in response to citrullinated bacteria.

The results may explain why arthritis treatments do not work as well in patients with gum disease. If the gums are continuously releasing immune triggers into the bloodstream, treating arthritis without first solving the periodontal problem is like trying to haul water out of a ship without first plugging up its leaks.

“Gum disease is quite curable; rheumatoid arthritis can be much more difficult to treat,” Orange says. “Our results indicate that periodontal disease leads to leaky gums that allow oral bacteria to enter the blood repeatedly. This level of oral bacteria in blood doesn’t cause obvious symptoms, so the patients were not aware this was happening, but they do trigger inflammatory and auto-antibody responses that are highly relevant to rheumatoid arthritis.”

These findings also demonstrate the importance of conducting long-term research to better understand chronic diseases. The present study would not have been possible without a unique initiative, pioneered by Orange and Darnell several years ago, that empowers arthritis patients to collect their own blood samples at home with a finger-prick kit and mail weekly samples to Rockefeller. The lab now has several years of data to help track what happens in the blood right before an arthritis flare.

“Without having weekly blood samples for at least a year, we wouldn’t have been able to find out what was happening before the patients had symptoms of their flares,” Orange says. “Our study revealed a plausible mechanism to explain why rheumatoid arthritis patients with periodontal disease do not respond well to treatment—something very hard to capture without long-term monitoring.”

https://www.eurekalert.org/news-releases/986400 

New Research: Taking Care of Your Teeth Could Help Prevent Chronic Joint Pain

From scitechdaily.com

A researcher at Rice University discovers a critical piece of information in discarded data that redirects their research in the right direction

Regular dental check-ups could potentially alleviate joint pain. When Vicky Yao, a computational biologist from Rice University, discovered the presence of bacteria linked to periodontal disease in samples taken from individuals suffering from rheumatoid arthritis, she was not sure what to make of it.

Her discovery ignited a series of experiments that established a correlation between arthritis flare-ups and periodontitis. The research results have been published in the journal Science Translational Medicine.

Tracing this connection between the two conditions could help develop therapies for rheumatoid arthritis, an autoimmune inflammatory disease that attacks the lining of the joints and can cause heart-, lung- and eye-problems. The approach that led to the study could prove fruitful in other disease contexts, such as cancer.

“Data gathered in experiments from living organisms or cells or tissue grown in Petri dishes is really important to confirm hypotheses, but, at the same time, this data perhaps holds more information than we are immediately able to derive from it,” Yao said.

Yao’s hunch was confirmed when she took a deeper look into data collected from rheumatoid arthritis patients by Dana Orange, an associate professor of clinical investigation and a rheumatologist, and Bob Darnell, a professor and attending physician at Rockefeller University and the Howard Hughes Medical Institute.

Yao was collaborating with Orange and others on a different project that tracked changes in gene expression during rheumatoid arthritis flare-ups.

“Orange, working with Darnell, collected data from arthritis patients at regular intervals while, at the same time, monitoring when the flares happened,” Yao said. “The idea was that perhaps by looking at this data retroactively, some pattern would become visible giving clues as to what might cause the arthritis to flare up.

“While I was working on that project, I went to this talk that I thought was really cool because it pointed out that in the data that gets ignored or thrown out, you can actually find traces of microbes. You’re looking at a human sample but you get a snapshot of the microbes floating around. I was intrigued by this.”

When she looked into it, Yao found that the germs in the samples that changed consistently across patients prior to flares were largely ones associated with gum disease.

“I was curious about this tool that allowed you to detect microbes in human samples. It was sort of like, for free, you’re getting an extra perspective on the data,” Yao said. “At the time, I hadn’t worked much on microbial data at all. Since then, Dana leveraged all this expertise and got together with people studying these bacteria.

“One of the things that came up when we were discussing this was, how cool would it be if you could prescribe some kind of mouthwash to help prevent rheumatoid arthritis flares.”

https://scitechdaily.com/new-research-taking-care-of-your-teeth-could-help-prevent-chronic-joint-pain/

To avoid rheumatoid arthritis flare-ups, get your teeth cleaned, Rice University researcher says

From houstonchronicle.com

Bacteria associated with gum disease can worsen rheumatoid arthritis flare-ups, researchers found

Getting your teeth cleaned on a regular basis could prevent rheumatoid arthritis flare-ups, according to a Rice University researcher.

Bacteria associated with gum disease can worsen rheumatoid arthritis flare-ups. The bacteria enters the bloodstream when a person’s gums are bleeding, and then it can mislead the body’s natural defences into attacking joint tissue because the bacteria and the tissue have similar-looking proteins. 

So maintaining good dental hygiene may prevent flare-ups by preventing this bacteria from entering the body and tricking the immune system, said Rice University computational biologist Vicky Yao.

                                                                 Jennifer Whitney/San Antonio Express-News

Yao was part of a team of researchers who published their findings last month in Science Translational Medicine. The study was led by R. Camille Brewer from Stanford University.

Tracing this connection between the two conditions could help develop therapies for rheumatoid arthritis, an autoimmune inflammatory disease that attacks the lining of the joints and can cause heart, lung and eye problems, according to a Rice University news release. 

“How cool would it be if you could prescribe some kind of mouthwash to help prevent rheumatoid arthritis flares,” Yao said in the news release.

https://www.houstonchronicle.com/news/houston-texas/health/article/rheumatoid-arthritis-teeth-cleaning-rice-study-17822859.php

What to Know About Psoriatic Arthritis and Dental Problems

From healthline.com

Psoriatic arthritis (PsA) is an autoimmune disease that most often attacks and damages joints in your hands, feet, wrists, knees, neck, and spine. Yet it also can affect the temporomandibular joint (TMJ) in your jaw.

You actually have two temporomandibular joints — one on either side of your head, in front of your ears. The TMJ connects your jawbone to your skull. It allows your jaw to open and close like a hinge.

Problems with the TMJ are referred to as temporomandibular joint disorder (TMD). TMD causes pain and difficulty moving your jaw.

Up to 35 percent of people with PsA have TMD. When you have PsA, your TMD symptoms may be more severe.

TMJ pain makes it hard to eat and enjoy food. If you don’t get treated, damage to your jaw could be with you long term. That’s why it’s important to let your dentist and rheumatologist know if you have joint pain or any other TMD symptoms.

Can PsA cause jaw pain?

PsA can cause TMJ pain. It often starts in the morning or late afternoon. It may hurt more when you chew.

The pain can spread from your jaw to other parts of your face, as well as to your shoulder, neck, or back. Some people with TMD report having headaches or earaches.

Other symptoms of TMD are:

• a clicking, popping, or crackling sound when you open and close your jaw
• trouble opening and closing your mouth
• a feeling like your jaw is stuck or locked
• grinding your teeth, called bruxism
• dizziness
• tooth sensitivity and pain
• a misaligned bite

TMD can make you tense or clench your jaw. In turn, clenching makes TMD worse.

Eventually your TMJ can wear out completely, at which point you may need surgery.

PsA and periodontal disease

There’s also a link between PsA and gum disease (periodontitis).

Periodontitis starts when bacteria build up on your teeth and gums. These bacteria release toxins that produce inflammation, which damages your gums and can lead to tooth loss.

Psoriasis and PsA are inflammatory diseases, and they increase your risk for periodontitis and tooth decay. The more severe your PsA symptoms, the more likely you are to have gum disease.

How can PsA affect dental implants?

Dental implants are part of the treatment for tooth loss. These synthetic roots go into your jawbone to hold artificial teeth called crowns.

The biologic drugs you take to treat PsA may cause problems with dental implant surgery. These drugs dampen your immune system, which could increase your risk of infection.

So, you may need to switch arthritis drugs or take antibiotics before oral surgery to prevent infection.

It’s unknown whether having PsA might make dental implants more likely to fail. Still, it’s a good idea to let your dental surgeon know about your PsA before you have any surgery.

Research from 2017 shows that dental implants are more likely to fail in people with rheumatoid arthritis (RA). Some of the reasons why implants fail in people with RA are:

• Their body doesn’t heal as quickly as usual.
• They have gum disease.
• They don’t make enough saliva.

How to treat

The anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (DMARDs) that treat PsA can also prevent jaw damage. These medications bring down inflammation to relieve pain and protect your joints.

Physical therapy is another treatment for TMD. The therapist can teach you exercises to stretch your jaw and strengthen the muscles that support it. You’ll also learn how to keep your head and neck in better alignment to avoid putting extra strain on your jaw.

Along with taking medication, try these lifestyle changes:

• Rest your jaw until your symptoms improve.
• Avoid eating nuts and other hard foods and chewing gum. Stick to soft foods.
• Practice relaxation techniques, such as meditation and deep breathing, to help ease tension in your jaw.
• Ask your dentist to fit you for a mouth guard. You can wear this device when you sleep to stop you from grinding your teeth.
• Hold an ice pack or heating pad to your jaw.
• Rub on an arthritis pain cream (but ask your doctor first).

It’s rare to need surgery for TMD, but it may be an option if these treatments don’t improve your symptoms.

Arthroplasty is done through small incisions. The surgeon removes scars and thick areas of tissue that prevent your jaw from opening and closing as it should.

Open surgery may be an option if the surgeon needs to repair or replace the damaged joint. Open surgery is riskier than arthroplasty, however, and it’s only done when absolutely necessary.

The takeaway

Early treatment of TMD is key to preventing long-term joint damage.

If you notice any clicking, popping, or pain in your jaw, see both a dentist and the rheumatologist who treats your PsA. They might send you to a specialist called an oral and maxillofacial surgeon.

Prevent gum disease by practicing good oral hygiene. Brush after every meal, and floss once per day to remove food particles between your teeth. See your dentist for regular check-ups.

If you plan to have oral surgery, let your surgeon know that you have PsA. You may need to go on antibiotics beforehand or take special precautions to prevent infection and other complications.

https://www.healthline.com/health/psoriatic-arthritis/jaw-pain-and-more#treatment

The 6 things you're doing that could make arthritis worse

From news4jax.com/health

Certain habits could be making arthritis symptoms more painful

If you have arthritis, you know all about the pain, swelling, and stiffness that the disease brings on. 
According to the Centres for Disease Control and Prevention, more than 54 million people in the U.S. suffer from some type of arthritis. It’s the leading cause of disability.
                                
“We’re seeing arthritis at an earlier age, not only in the knees but shoulders, really everywhere. It’s becoming an epidemic of sorts," said Dr. Mathew Pombo, of Emory Orthopedics & Spine Center.

There are lots of medicines to make arthritis symptoms better, but there are also things you do that can make it worse.

Staying still is the first mistake that can intensify your pain. Regular physical activity makes your joints more flexible.

But too much exercise can also be a bad thing.
“We also have a lot of younger people participating in sports, and we know that prior injury leads to post-traumatic arthritis,” Pombo said.
Try swimming, biking or walking for about 30 minutes a day.

Ignoring your dental health may also lead to worse problems. One study found the bacterium that causes periodontal disease increases the severity of rheumatoid arthritis.

The wrong foods can also cause inflammation in the body and trigger symptoms. Some ingredients to avoid: sugar, saturated fats, refined carbs, Omega-6 fatty acids, MSG, gluten, aspartame and alcohol.

Stress could make your symptoms worse. A traumatic or stressful situation can actually trigger the development of certain types of arthritis.
Yoga, meditation, and getting enough sleep can help you manage your stress levels. 

Smoking is another bad move. Recent research shows both current and past smokers with arthritis had worse symptoms and more joint damage than those who never smoked. 

https://www.news4jax.com/health/the-6-things-youre-doing-that-could-make-arthritis-worse

Arthritis: Here are the foods and activities to avoid that make it worse

From abc7.com/health

More than 54 million people in the United States suffer from some type of arthritis.

It's the leading cause of disability.

There are lots of medicines to make arthritis symptoms better, but there are also things you do that can make it worse.

If you have arthritis, you know all about the pain, swelling and stiffness that the disease brings on.

Dr. Mathew Pombo with the Emory Orthopaedics & Spine Centre said, "We're seeing arthritis at an earlier age, not only in the knees, but shoulders, really everywhere. It's becoming an epidemic of sorts."

But did you know certain habits can make your symptoms worse?

Staying still is the first mistake that can intensify your pain.

Regular physical activity makes your joints more flexible. But too much exercise can also be a bad thing.

"We also have a lot of younger people participating in sports and we know that prior injury leads to post-traumatic arthritis," said Pombo.

Try swimming, biking or walking for about 30 minutes a day.

Ignoring your dental health may also lead to worse problems. One study found the bacterium that causes periodontal disease increases the severity of rheumatoid arthritis.

The wrong foods can also cause inflammation in the body and trigger symptoms.

Some ingredients to avoid: sugar, saturated fats, refined carbs, omega-six fatty acids, MSG, gluten, aspartame and alcohol.

Lastly, stress could make your symptoms worse.

A trauma or stressful situation can actually trigger the development of certain types of arthritis.

Yoga, meditation and getting enough sleep can help you manage your stress levels.

Smoking is another bad move. Recent research shows both current and past smokers with arthritis had worse symptoms and more joint damage than those who never smoked.

https://abc7.com/health/the-top-things-you-do-that-make-arthritis-worse/5593111/