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Periodontal disease and subgingival microbiota as contributors for rheumatoid arthritis pathogenesis: modifiable risk factors?

Scher, Jose U.a,b,*; Bretz, Walter A.c,*; Abramson, Steven B.a,b

Current Opinion in Rheumatology: July 2014 - Volume 26 - Issue 4 - p 424–429
doi: 10.1097/BOR.0000000000000076

Purpose of review Since the early 1900s, the role of periodontal disease in the pathogenesis of rheumatoid arthritis has been a matter of intense research. The last decade has witnessed many advances supporting a link between periodontitis, the presence of specific bacterial species (i.e. Porphyromonas gingivalis) and their effects in immune response. This review will examine available evidence on the individuals.

Recent findings Epidemiological studies have stressed the commonalities shared by periodontal disease and rheumatoid arthritis. Many groups have focused their attention toward understanding the periodontal microbiota and its alterations in states of health and disease. The presence of circulating antibodies against periodontopathic bacteria and associated inflammatory response has been found in both rheumatoid arthritis (RA) patients and individuals at-risk for disease development. Most recently, the periodontal microbiota of smokers and patients with RA has been elucidated, revealing profound changes in the bacterial communities compared with those of healthy controls. This has led to several small clinical trials of progressive disease treatment as adjuvant for disease-modifying therapy in RA.

Summary Smoking and periodontal disease are emerging risk factors for the development of RA. Epidemiological, clinical, and basic research has further strengthened this association, pointing toward changes in the oral microbiota as possible contributors to systemic inflammation and arthritis.

aDivision of Rheumatology and Microbiome Center for Rheumatology and Autoimmunity, New York University Hospital for Joint Diseases

bDivision of Rheumatology and Department of Medicine, New York University School of Medicine

cDepartment of Cariology and Comprehensive Care, New York University College of Dentistry, New York, New York, USA

*Jose U. Scher and Walter A. Bretz contributed equally to this work.

Correspondence to Jose U. Scher, MD, Division of Rheumatology and Microbiome Center for Rheumatology and Autoimmunity (MiCRA), New York University Hospital for Joint Diseases, 301 East 17th Street, Room 1611, New York, NY 10003, USA. Tel: +1 212 598 6153; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.