It might not seem an obvious association but many patients with rheumatoid arthritis suffer both with Neck pain and gum disease, and a new study adds to the weight of evidence supporting a link between the two. The research, published this month in the Annals of Rheumatic Diseases, found that RA patients were four times more likely to have gum disease than the non-smokers they studied. Whilst isolated neck and jaw pain may result from a tooth infection or gum disease causing acute inflammation, this association between rheumatoid arthritis and gum disease has consequence for all of the joints in the body as well as the general health of patients.
The theory is that RA may be triggered in genetically susceptible people by an immune response to a major pathogen involved in gum disease, Porphyromonas gingivalis. What does this mean in terms of reducing the risk of RA or coping with an existing condition, and why might those with gum disease and neck pain wish to see their doctor straight away?
Severe RA, DMARD-Resistance, and Periodontal Disease
Indian researchers in Hyderabad are behind the latest study which looked at ninety-one patients with Rheumatoid arthritis and ninety-three age- and sex-matched healthy control subjects. The participants were all non-smokers who had not, as yet, been treated with disease-modifying antirheumatic drugs. Smoking and DMARDs are associated with an increased risk of RA and periodontal disease in advanced RA patients, respectively. Measurements taken during the study included mean pocket depth (MPD) at the roots of the teeth, the concentration of anticitrullinated peptide antibodies (ACPAs), and titers of immunoglobulin M-rheumatoid factor (IgM-RF).
Early Signs of Rheumatoid Arthritis
Patients with gum disease normally respond by producing citrullinated peptides but patients with rheumatoid arthritis experience this unique response to the peptides, often years before the autoimmune condition itself arises. In this study the patients with rheumatoid arthritis were 4.28 times more likely to have evidence of periodontal disease, with 64.83% of RA patients showing signs compared to 28% of control subjects. The MPD was 3.61mm in RA patients compared to 2.46mm in controls, and gum disease is usually indicated when MPD is 3mm or more. Titers of IgM-RF and ACPA were higher in the patients with rheumatoid arthritis and there was a positive correlation between MPD and ACPA titers but no significant correlation between IgM-RF-positive patients and MPD.
Gum Disease, Neck Pain, and Rheumatoid Arthritis
The study adds to evidence that there is a link between gum disease and rheumatoid arthritis, and that ACPA is associated with severe RA development. Those with periodontal disease may be more likely to have severe RA and be resistant to DMARD therapy but more research is necessary to confirm such a theory. Those with a family history of RA or autoimmune conditions may, in the meantime, be inclined to monitor gum health and take extra precautions against gum disease, by quitting smoking or chewing tobacco, ensuring adequate vitamin C, brushing and flossing teeth properly, and reducing sugar consumption, for example. Keeping oral hygiene optimal could help those who are genetically susceptible to RA avoid the pathogen that appears to trigger the condition. Additionally, those with gum disease and neck pain or other symptoms of rheumatoid arthritis may wish to consult their physician to test for the illness sooner rather than later.
Potikuri, D., Chakravarthy Dannana, K., et al, (2012), Periodontal disease is significantly higher in non-smoking treatment-naive rheumatoid arthritis patients: results from a case-control study, Ann Rheum Dis. 2012;71:1541-1544.