GS2: Robert J. Genco Perio-Systemic Symposium
Presenters
Description
Topic: Periodontal Health and Rheumatoid Arthritis
Oral health and overall health are frequently misperceived as distinct domains. Periodontitis (PD), a prevalent infectious inflammatory disease globally, is associated with various systemic conditions, including diabetes, cardiovascular diseases, neurodegenerative diseases, and rheumatoid arthritis. Although the specific mechanisms linking PD to these systemic diseases remain uncertain, common underlying factors exist. Rheumatoid arthritis (RA) and PD are both chronic inflammatory conditions, albeit impacting different anatomical sites (joints and oral tissues). There is emerging evidence suggesting a bidirectional relationship between these conditions. Recent research indicates that inflammation and microorganisms at mucosal sites, such as the oral mucosa, gut, and lungs, may trigger autoimmunity and the development of joint disease in susceptible individuals. Individuals with RA exhibit a higher prevalence of PD compared to those without RA, and the severity of periodontal disease tends to be exacerbated in individuals with RA.
This session will delve into recent developments in our comprehension of the interconnection between RA and periodontitis, providing fresh insights into the molecular mechanisms through which PD contributes to and is impacted by RA. It will offer a comprehensive review of the scientific evidence linking RA and PD, highlighting shared pathogenic mechanisms. Additionally, it will explore how insights into this association can inform prevention and treatment strategies for both conditions. Specifically, antibodies to citrullinated antigens and immune-mediated destruction of synovial joints are the hallmarks of rheumatoid arthritis (RA). Understanding why citrullinated proteins become immunogenic in this disease is believed to inform the origins of autoimmunity in RA. Because citrullination is a physiologic post-translational modification, one theory is that conditions promoting abnormal citrullination are initiators of self-reactive immune responses to citrullinated proteins in RA. Periodontal disease is common in RA, and periodontal pathogens have been implicated as potential disease triggers by inducing citrullinated antigens. When we explore this link using the lens of the ever-present oral microbiome, we discover a circular relationship between the two diseases, highlighting the importance of periodontal care in RA management pathways and emphasizing the need for closer working relationships between rheumatologists and oral healthcare professionals. In addition, the circular model of RA pathogenesis includes the host response. Exploring another side of the host response will be focused on neutrophil extracellular traps and a series of studies will be presented that make the case for post-translational modifications of proteins within periodontal tissues derived from NET formation, as one potential trigger for the break in immune tolerance that generates autoimmunity in RA.Educational Objectives
- • Recognize the common risk factors that underpin RA and periodontitis and the evidence for common pathways of autoimmunity between the two.
- • Understand the role of RA in oral microbial dysbiosis.
- • Identify pathways by which periodontal pathogens drive the production of citrullinated antigens.
- • Disseminate knowledge underscoring the broad implications of oral health, emphasizing its impact on joint and bone health, and reciprocally, the relationship of these aspects with oral health.
CE Hours: 2
