What does gum disease have to do with juvenile and adult rheumatoid arthritis?

Does your child have seropositive juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA)? JRA is such a devastating, crippling disease, but have you wondered how your previously healthy child could have suddenly become so ill and if antibiotic therapy could really be a valid treatment?

A study, published earlier this year by BioMed Central in the online medical journal, Pediatric Rheumatology, has made a correlation to the Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis. The research concluded:

Children with CCP-positive JIA have higher antibody titers to P. gingivalis and more symptoms of poor oral health, supporting a possible role for periodontitis in the etiology of CCP-positive JIA.

In 2009, a similar study was published in the online journal, Int Immunopharmacol, entitled, Antibody responses to Porphyromonas gingivalis (P. gingivalis) in subjects with rheumatoid arthritis and periodontitis.  The researchers comment in a concluding study discussion that,

The association of this infection with select anti-CCP antibody isotypes and CRP concentrations suggests that infection with this bacterium may play a role in some patients with RA, affecting both adaptive and non-specific inflammatory pathways.

You might be wondering, what does an isolated focal infection, like gum disease, have to do with either pediatric or adult forms of RA?  After all, there is a pretty good chance that at some stage in life, most people will experience dental health issues, but most won’t be diagnosed with an inflammatory, destructive joint disease.  Wasn’t this old theory already debunked long ago?

On the contrary, it appears that this theory still bears merit and has resurfaced in the shape of the frozen remains of a 5300-year-old mummy, nicknamed Ötzi.  Significant clues have been found as a result of the study of his preserved body, recovered from the ice of a melting glacier in the Alps in 1991. This mummy has been analyzed for the past 25 years and much has been learned about his hunter-gatherer lifestyle, diet and health complaints. During one such investigation, an oral bacteria, a spirochete, called, Treponema denticola, was identified in Ötzi’s hip and subsequent speculation raised the question of just how it got there, as reported in the U.K.’s International Business Times (2014).

Unexpectedly, the researchers detected a sizable presence of the bacteria in the tiny bone sample, which provided information that the pathogen seems to have been distributed via the bloodstream from the mouth to the hip bone.

The logical questions that must follow are how such a focal infection winds up at distant sites in the body and can traveling infections persist to cause damage in other tissues? Teeth are, after all, a kind of joint, as the root sits in a socket that is attached to surrounding ligaments and is served by nerves and a circulatory system, similar to any joint in the body. It’s also broadly acknowledged that dental infections can become systemic, if left untreated, traveling from the oral cavity, via the circulatory system that feeds the teeth. Anyone with mitral valve prolapse of the heart may be familiar with the need to be treated prophylactically with antibiotics prior to any dental work in order to prevent infection from spreading to this vital organ.

A more reasonable question, therefore, might be, “Why wouldn’t a bacteria that enjoys inhabiting pockets in the gums, causing inflammation and triggering the production of anti-CCP autoantibodies in those genetically predisposed, that is capable of destroying the surrounding bone and connective soft tissues of teeth, also seek to take up residence in similar tissues throughout the body?” To this point, why wouldn’t antibiotic therapy be a reasonable treatment choice for both adult and juvenile forms of RA in much the same way that a painful, destructive dental infection is treated?

To read further on this topic:

John Hopkins Arthritis Center Rheumatology Rounds (July 9, 2010): Round 34: Periodontal Disease and Rheumatoid Arthritis:

A patient-friendly blog, “My RA Diary,” has provided an in-depth look at the correlation of dental infections with RA, in an article entitled, Look to Thy Mouth: It Might be the Source of your Rheumatoid Arthritis.