Rheumatoid Arthritis, Periodontal Disease Link Suggests Benefits in Behavioral Change

If you smoke, stop: The deleterious effect of smoking on both PD and RA activity is well known. Recent data suggest that smoking cessation may have benefits on both RA activity and PD intensity.

Lose weight: Weight loss has yet to be shown to improve rheumatoid disease activity. But more and more, it has been recognized that RA activity is associated with excess morbidity and mortality due to cardiovascular complications (e.g., stroke, heart attack). Weight loss regimens should be instituted to reduce modifiable cardiovascular risk factors.

Maintain proper dental care: Encourage patients to brush regularly and floss daily. They should have a baseline examination by their general dentist. “Further evaluation (general dental care versus specialist periodontist care) and treatment (e.g., scaling, root planing) would hinge on the magnitude of their gum disease,” Dr. Rosenstein says.

In commenting on the recommendations, Jeffrey Sparks, MD, MMSc, instructor of medicine, Brigham and Women’s Hospital, Boston, notes that healthy behaviors have been linked to decreased risk of RA and may improve outcomes in patients with RA. “However, the research is not currently strong enough to prescribe these behaviors instead of disease-modifying antirheumatic drugs (DMARDs),” he says.

More to Learn

More research is needed to understand the biologic mechanisms that these behaviors work through. “We also need to understand how much impact these behaviors have on RA risk and outcomes,” Dr. Sparks continues. But recommending fish intake, smoking cessation, weight loss, and proper dental care to patients with RA has little downside but carries the potential to improve patient outcomes. “We could even consider offering similar advice to those who are at high risk of RA in order to potentially decrease their RA risk,” he says.

Dr. Sparks

“We also need to clearly understand how important these behaviors are to patients with RA,” he says. “We need to quantify how much these behaviors contribute to the risk of RA and for poor outcomes in RA patients.” Most studies associate these factors with increased risk of RA or poor outcomes in RA patients. However, it’s not known that changing these behaviors actually decreases RA risk.

“Behavioral change is difficult to implement, but this is clearly an important area of research,” Dr. Sparks concludes. “These public health measures could have a big impact on improving RA—and potentially even prevent RA—which is an exciting area of research.”

Looking Back

Dr. Rosenstein says he was prompted to review the literature because, for decades, the similarities between PD and RA had been well known—practitioners in both fields would often observe and comment on the similar mechanisms of inflammation and their consequences.