Gums and Joints: The Link Between Oral Health and Rheumatoid Arthritis

People with rheumatoid arthritis often experience more gum problems. Certain oral bacteria and the substances they release can worsen the symptoms of this disease, so maintaining good oral hygiene not only protects your teeth and gums but also helps reduce overall inflammation in the body and improve arthritis management.

Is there a link between gum disease and rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease in which the immune system attacks the joints, causing inflammation, pain, and stiffness, especially in the morning. It can affect various joints in the body, including the jaw in up to 30% of cases. Over time and due to inflammation, the cartilage and underlying bone can be affected, and, in advanced cases, lead to ankylosis or joint fusion.

Several studies have shown that people with RA tend to have more gum problems, such as gingivitis or periodontitis. For example, in a study of 144 patients, more than 80% had inflamed gums and more than 33% had moderate periodontitis. Furthermore, treating gum disease in people with RA helps reduce inflammation and improves joint symptoms.

Both rheumatoid arthritis and periodontitis share important characteristics: chronic inflammation, tissue damage, and activation of the immune system. Furthermore, they can affect bone density, increasing the risk of osteoporosis and fractures.

How Oral Inflammation Can Affect Joint Health

Gum Gum inflammation can activate the body’s immune system, while RA can worsen inflammatory processes in the mouth. This relationship is due both to the bacteria present in the oral cavity and to the release of inflammatory mediators.

1. Oral bacteria

Some bacteria involved in periodontitis, such as Porphyromonas gingivalis, produce an enzyme called peptidyl-arginine deiminase (PPAD). This enzyme promotes protein citrullination, a process that can induce the formation of antibodies against citrullinated proteins (ACPA), which are considered key markers and pathogenic factors in rheumatoid arthritis. This mechanism contributes to the autoimmune response and may increase inflammation in the joints.

Other bacteria such as Aggregatibacter actinomycetemcomitans can also stimulate the immune system’s response and worsen overall inflammation.

2. Inflammatory mediators

Gum inflammation triggers the release of pro-inflammatory cytokines such as IL-1, IL-6, TNF-α, and prostaglandin E2, which can enter the bloodstream and affect the joints. Continuous exposure to bacteria also triggers the production of autoantibodies that attack joint tissues, increasing pain and bone damage.

The role of oral bacteria in systemic inflammation

When the gingival barrier is damaged by periodontitis, bacteria and their byproducts can trigger the immune system, increase C-reactive protein levels, and stimulate the synovial response. 

1. Activation of the immune system

The body's immune system goes on high alert to fight off infections or "problems" it has detected, and in the case of RA, this activation can be excessive or misdirected, attacking the body’s own tissues, such as the joints.

2. Elevated C-reactive protein (CRP)

C-reactive protein is a substance produced by the liver that is used as a marker: High CRP levels indicate active inflammation. It does not necessarily indicate the cause, but it helps doctors determine if arthritis is present.

3. Stimulation of the synovial response

The synovial membrane is the tissue that lines the joints and produces a fluid that lubricates them. When we talk about “stimulation of the synovial response,” we mean that the membrane becomes inflamed, producing more fluid and immune cells. This causes swelling, pain, and stiffness in the joint—symptoms typical of rheumatoid arthritis.

Why good oral hygiene is linked to a lower risk of arthritis

Since gum inflammation can send signals to the immune system that increase inflammation in other parts of the body, taking care of your gums and teeth every day prevents cavities and gum disease, as well as improves the symptoms of rheumatoid arthritis. 

1. Daily brushing and cleaning

As is always recommended, brush your teeth at least twice a day with fluoride toothpaste. Flossing or using interdental brushes helps remove plaque that builds up between your teeth.

2. Regular visits to the dentist

Have professional cleanings every 6 or 12 months helps prevent diseases such as gingivitis and periodontitis. If periodontal disease is already present, the specialist can perform more thorough treatments to reduce inflammation.

3. Management of risk factors

It is important to maintain a balanced diet, avoid smoking, and manage stress. Once at the dentist’s office, be sure to inform your dentist about your RA and any prescribed medications, as this information can be key to tailoring your dental treatment safely and to your individual needs.