Periodontal Mucosal Breaks Trigger RA Disease Activity Save

Periodontal disease (PD) is more common in rheumatoid arthritis (RA), especially those with anti-citrullinated protein antibodies (ACPAs).  RA activity has been linked to the severity of PD and mucosal inflammation.

Researchers from Standfod have suggested a prominent role for PD in the pathogenesis of RA by showing PD related mucosal breaches leading to citrullinated oral bacteria, which activate inflammatory monocytes contributing to RA synovitis and flares while also activaing ACPA+ B cells.

Serial blood samples were taking from 5 RA patients, with our without PD, for a year. Paired analysis of human and bacterial transcriptomics showed that RA patients with PD had repeated oral bacteremias associated with transcriptional signatures of ISG15+HLADRhi and CD48highS100A2pos monocytes. These subsets were temporally linked to citrullinated oral bacteria targeting somatically hypermutated ACPAs encoded by RA blood plasmablasts.   

These findings suggest that periodontal disease breaches the oral mucosa and triggers innate and adaptive immune responses, which, when repeated over time in a susceptible host, likely contribute to the pathogenesis of RA.