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Rockefeller University » Periodontal disease may be at the root of arthritis flare-ups
It’s a well-documented medical mystery: patients with periodontal disease are less likely to respond to rheumatoid arthritis treatment. may help explain this relevance. was announced in Science Translational Medicinesuggests that when damaged gums are ruptured, bacteria in the mouth can seep into the bloodstream, activating an immune response that ultimately targets the body’s own proteins to trigger arthritis flare-ups. .
“Oral bacterial invasion and repeated triggering of the immune response associated with rheumatoid arthritis can be difficult to treat,” said Dana Orange, a clinical research professor in the Robert B. Darnell lab at The Rockefeller University. says. “When a doctor encounters an arthritis patient who does not respond to treatment, it is worth making sure that the underlying periodontal disease is not overlooked, which is fully treatable.”
Darnell Laboratories When they were following a small group of arthritis patients for several years, collecting weekly blood samples and looking for changes in gene expression to help explain why painful flare-ups occurred, they discovered We noticed a surprising trend. Two patients with moderate to severe periodontal disease had repeated episodes of oral bacteria in their bloodstream even when they were not receiving dental care.
Orange knew that people with rheumatoid arthritis commonly have autoantibodies in their bloodstream (rheumatoid arthritis is an autoimmune disease in which antibodies attack the body’s own proteins and peptides). Autoantibodies often target proteins that show signs of citrullination. This is the process by which her one amino acid in the protein is converted to another amino acid.
After further testing, the researchers found that the oral bacteria detected in the blood were also citrullinated in the oral cavity, similar to proteins targeted by arthritic autoantibodies. They next demonstrated that the same autoantibodies that attack the body’s citrullinated proteins are activated in response to citrullinated bacteria.
This result may explain why arthritis treatments fail in patients with periodontal disease. Treating arthritis without it is like trying to get water out of a ship without plugging the leak first.
“Gum disease is completely cured. Rheumatoid arthritis can be much more difficult to treat,” says Orange. This level of oral bacteria in the blood does not cause obvious symptoms, so the patient was unaware that this was happening, but rheumatoid arthritis. provokes inflammatory and autoantibody responses that are highly relevant to
These findings also demonstrate the importance of conducting longitudinal studies to better understand chronic diseases. Current research would not have been possible without the original initiative pioneered by Orange and Darnell several years ago. It allows arthritis sufferers to collect their own blood samples at home using a finger prick kit and have the samples mailed to Rockefeller each week.The lab now has several years of data to help track What happens in the blood just before arthritis recurs?
“Without weekly blood samples for at least a year, we wouldn’t have been able to figure out what was going on before the patient showed symptoms of a flare-up,” says Orange. “Our study reveals a plausible mechanism explaining why rheumatoid arthritis patients with periodontal disease respond poorly to treatment, which is very difficult to grasp without long-term monitoring. That’s it.”
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