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Periodontitis and Rheumatoid Arthritis: the Common Thread

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A Correction to this article was published on 14 December 2021

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Abstract

Periodontitis (PD) and rheumatoid arthritis (RA) are immuno-inflammatory diseases where leukocyte infiltration and inflammatory mediators induce alveolar bone loss, synovitis and joint destruction, respectively. One percent of the human population is affected by RA which is an autoimmune disease that target modified self-epitopes while 11% of the global adult population are affected by severe chronic periodontitis in which commensal microflora on the tooth surface is replaced by a dysbiotic consortium of bacteria that promote the chronic inflammatory destruction of periodontal tissue. Despite differences in aetiology, RA and periodontitis show similarity in terms of pathogenesis; both diseases involve chronic inflammation fuelled by pro-inflammatory cytokines, connective tissue breakdown and bone erosion. The two diseases also share risk factors such as smoking and ageing and have strong epidemiological, serological and clinical associations. In this review aetiology, clinical and experimental evidence supporting this association is discussed and the potential mechanisms involved in linking periodontitis to RA are presented.

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Abbreviations

ACPAs:

Anti-citrullinated protein antibodies

AMPAs:

Anti-modified protein antibodies

COX:

Cyclooxygenase

DMARDs:

Disease-modifying anti-rheumatic drugs

LPS:

Lipopolysaccharides

PAD:

Peptidylarginine deiminases

PD:

Periodontitis

References

  1. Weyand CM. New insights into the pathogenesis of rheumatoid arthritis. Rheumatology (Oxford). 2000;39(1):3–8.

    Google Scholar 

  2. Short CL. The antiquity of rheumatoid arthritis. Arthritis Rheum. 1974;17(3):193–205.

    CAS  PubMed  Google Scholar 

  3. Snyderman R, McCarty GA. Analogous mechanisms of tissue destruction in rheumatoid arthritis and periodontal disease. I. In: Genco RJ, Mergenhagen SE, editors. HosteParasite interaction in periodontal diseases. Washington, DC; 1982

  4. Shah A. Harrison’s principles of internal medicine. 18th ed. United States: McGraw Hill; 2012. p. 2738.

    Google Scholar 

  5. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580–8.

    PubMed  Google Scholar 

  6. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315–24.

    CAS  PubMed  Google Scholar 

  7. Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: the polymicrobial synergy and dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol. 2012;27(6):409–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Gomes MS, Blattner TC, Filho MS, Grecca FS, Hugo FN, Fouad AF, et al. Can apical periodontitis modify systemic levels of inflammatory markers? A systematic review and meta-analysis. J Endod. 2013;39(10):1205–17.

    PubMed  Google Scholar 

  9. Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res. 2002;4(3):265–72.

    Google Scholar 

  10. Mikuls TR, Payne JB, Deane KD, Thiele GM. Autoimmunity of the lung and oral mucosa in a multisystem inflammatory disease: the spark that lights the fire in rheumatoid arthritis? J Allergy Clin Immunol. 2016;137(1):28–34.

    CAS  PubMed  Google Scholar 

  11. Mankia K, Emery P. Is localized autoimmunity the trigger for rheumatoid arthritis? Unravelling new targets for prevention. Discov Med. 2015;20(109):129–35.

    PubMed  Google Scholar 

  12. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023–38.

    CAS  PubMed  Google Scholar 

  13. Klareskog L, Lundberg K, Malmström V. Autoimmunity in rheumatoid arthritis: citrulline immunity and beyond. Adv Immunol. 2013;118:129–58.

    CAS  PubMed  Google Scholar 

  14. Muller S, Radic M. Citrullinated autoantigens: from diagnostic markers to pathogenetic mechanisms. Clin Rev Allergy Immunol. 2015;49(2):232–9.

    CAS  PubMed  Google Scholar 

  15. Trouw LA, Rispens T, Toes REM. Beyond citrullination: other post-translational protein modifications in rheumatoid arthritis. Nat Rev Rheumatol. 2017;13(6):331–9.

    CAS  PubMed  Google Scholar 

  16. Wang S, Wang Y. Peptidylarginine deiminases in citrullination, gene regulation, health and pathogenesis. Biochim Biophys Acta. 1829;2013:1126–35.

    Google Scholar 

  17. Gyorgy B, Toth E, Tarcsa E, Falus A, Buzas EI. Citrullination: a posttranslational modification in health and disease. Int J Biochem Cell Biol. 2006;38(10):1662–77.

    PubMed  Google Scholar 

  18. Makrygiannakis D, Hermansson M, Ulfgren AK, Nicholas AP, Zendman AJW, Eklund A, et al. Smoking increases peptidylarginine deiminase 2 enzyme expression in human lungs and increases citrullination in BAL cells. Ann Rheum Dis. 2008;67(10):1488–92.

    CAS  PubMed  Google Scholar 

  19. Nesse W, Westra J, Jacqueline E, Abbas F, Nicholas AP, Vissink A, et al. The periodontium of periodontitis patients contains citrullinated proteins which may play a role in ACPA (anti-citrullinated protein antibody) formation. J Clin Periodontol. 2012;39(7):599–607.

    CAS  PubMed  Google Scholar 

  20. Bennike TB, Ellingsen T, Glerup H, Bonderup OK, Carlsen TG, Meyer MK, et al. Proteome analysis of rheumatoid arthritis gut mucosa. J Proteome Res. 2017;16(1):346–54.

    CAS  PubMed  Google Scholar 

  21. Konig MF, Abusleme L, Reinholdt J, Palmer RJ, Teles RP, Sampson K, et al. Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Sci Transl Med. 2016;8:369ra176.

    PubMed  PubMed Central  Google Scholar 

  22. Vossenaar ER, Zendman AJ, van Venrooij WJ, Pruijn GJ. PAD, a growing family of citrullinating enzymes: genes, features and involvement in disease. Bioessays. 2003;25(11):1106–18.

    CAS  PubMed  Google Scholar 

  23. Arita K, Hashimoto H, Shimizu T, Nakashima K, Yamada M, Sato M. Structural basis for Ca2+-induced activation of human PAD4. Nat Struct Mol Biol. 2004;11(8):777–83.

    CAS  PubMed  Google Scholar 

  24. Robertson WG, Marshall RW, Bowers GN. Ionised calcium in body fluids. Crit Rev Clin Lab Sci. 1981;15(2):85–125.

    CAS  PubMed  Google Scholar 

  25. Potempa J, Mydel P, Koziel J. The case for periodontitis in the pathogenesis of rheumatoid arthritis. Nat Rev Rheumatol. 2017;13(10):606–20.

    CAS  PubMed  Google Scholar 

  26. Hirsch HZ, Tarkowski A, Koopman WJ, Mestecky J. Local production of IgA- and IgM-rheumatoid factors in adult periodontal disease. J Clin Immunol. 1989;9(4):273–8.

    CAS  PubMed  Google Scholar 

  27. Michalowicz BS. Genetic and heritable risk factors in periodontal disease. J Periodontol. 1994;65(5):479–88.

    CAS  PubMed  Google Scholar 

  28. Salvi GE, Yalda B, Collins JG, Jones BH, Smith FW, Arnold RR, et al. Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol. 1997;68(2):127–35.

    CAS  PubMed  Google Scholar 

  29. Ollier W, Thomson W. Population genetics of rheumatoid arthritis. Rheum Dis Clin North Am. 1992;18:741–59.

    CAS  PubMed  Google Scholar 

  30. Bendtzen K, Morling N, Fomsgaard A, Svenson M, Jakobsen B, Odum N, et al. Association between HLA-DR2 and production of tumour necrosis factor alpha and interleukin 1 by mononuclear cells activated by lipopolysaccharide. Scand J Immunol. 1988;28(5):599–606.

    CAS  PubMed  Google Scholar 

  31. Heasman LSF, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol. 2006;33(4):241–53.

    CAS  PubMed  Google Scholar 

  32. de Pablo P, Dietrich T, McAlindon TE. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol. 2008;35(1):70–6.

    PubMed  Google Scholar 

  33. Marotte H, Farge P, Gaudin P, Alexandre C, Mougin B, Miossec P. The association between periodontal disease and joint destruction in rheumatoid arthritis extends the link between the HLA-DR shared epitope and severity of bone destruction. Ann Rheum Dis. 2006;65(7):905–9.

    CAS  PubMed  Google Scholar 

  34. Johansson L, Sherina N, Kharlamova N, Potempa B, Larsson B, Israelsson L, et al. Concentration of antibodies against Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis. Arthritis Res Ther. 2016;18(1):201.

    PubMed  PubMed Central  Google Scholar 

  35. den Broeder AA, van Herwaarden N, van den Bemt BJF. Therapeutic drug monitoring of biologicals in rheumatoid arthritis: a disconnect between beliefs and facts. Curr Opin Rheumatol. 2018;30(3):266–75.

    Google Scholar 

  36. Bello-Gualtero JM, Lafaurie GI, Hoyos LX, Castillo DM, De-Avila J, Munevar JC, et al. Periodontal disease in individuals with a genetic risk of developing arthritis and early rheumatoid arthritis: a cross-sectional study. J Periodontol. 2016;87(4):346–56.

    CAS  PubMed  Google Scholar 

  37. Terao C, Asai K, Hashimoto M, Yamazaki T, Ohmura K, Yamaguchi A, et al. Significant association of periodontal disease with anti-citrullinated peptide antibody in a Japanese healthy population - the Nagahama study. J Autoimmun. 2015;59:85–90.

    CAS  PubMed  Google Scholar 

  38. Golub LM, Payne JB, Reinhardt RA, Nieman G. Can systemic diseases co-induce (not just exacerbate) periodontitis? A hypothetical “two-hit” model. J Dent Res. 2006;85(2):102–5.

    CAS  PubMed  Google Scholar 

  39. Rosenstein ED, Greenwald RA, Kushner LJ, Weissmann G. Hypothesis: the humoral immune response to oral bacteria provides a stimulus for the development of rheumatoid arthritis. Inflammation. 2004;28(6):311–8.

    PubMed  Google Scholar 

  40. Bartold PM, Marshall RI, Haynes DR. Periodontitis and rheumatoid arthritis: a review. J Periodontol. 2005;76(11):2066–74.

    CAS  PubMed  Google Scholar 

  41. Scardina GA, Messina P. Microvascular periodontal alterations: a possible relationship between perio dontitis and rheumatoid arthritis. Clin Hemorheol Microcirc. 2007;37(2):29–35.

    Google Scholar 

  42. Yusof Z, Porter SR, Greenman J, Scully C. Levels of serum IgG against Porphyromonas gingivalis in patients with rapidly progressive periodontitis, rheumatoid arthritis and adult periodontitis. J Nihon Univ Sch Dent. 1995;37(4):197–200.

    CAS  PubMed  Google Scholar 

  43. Yoshida A, Nakano Y, Yamashita Y, Oho T, Ito H, Kondo M, et al. Immunodominant region of Actinobacillus actinomycetemcomitans 40-kilodalton heat shock protein in patients with rheumatoid arthritis. J Dent Res. 2001;80(1):346–50.

    CAS  PubMed  Google Scholar 

  44. Moen K, Brun JG, Madland TM, Tynning T, Jonsson R. Immunoglobulin G and A antibody responsesto Bacteroides forsythus and Prevotella inter media in sera and synovial fluids of arthritis patients. Clin Diagn Lab Immunol. 2003;10(6):1043–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Ogrendik M, Kokino S, Ozdemir F, Bird PS, Hamlet S. Serum antibodies to oral anaerobic bacteria in patients with rheumatoid arthritis. Medscape Gen Med. 2005;7(2):2.

    Google Scholar 

  46. Moen K, Brun JG, Valen M, Skartveit L, Eribe EK, Olsen I, et al. Synovial inflammation in active rheumatoid arthritis and psoriatic arthritis facilitates trapping of a variety of oral bacterial DNAs. Clin Exp Rheumatol. 2006;24(6):656–63.

    CAS  PubMed  Google Scholar 

  47. Di Benedetto A, Gigante I, Colucci S, Grano M. Periodontal disease: linking the primary inflammation to bone loss. Clin Dev Immunol. 2013;503754.

  48. Uehara A, Imamura T, Potempa J, Travis J, Takada H. Gingipains from Porphyromonas gingivalis synergistically induce the production of proinflammatory cytokines through protease-activated receptors with Toll-like receptor and NOD1/2 ligands in human monocytic cells. Cell Microbiol. 2008;10(5):1181–9.

    CAS  PubMed  Google Scholar 

  49. Chukkapalli S, Rivera-Kweh M, Gehlot P, Velsko I, Bhattacharyya I, Calise SJ, et al. Periodontal bacterial colonization in synovial tissues exacerbates collagen-induced arthritis in B10. RIII mice. Arthritis Res Ther. 2016;18(1):161.

    PubMed  PubMed Central  Google Scholar 

  50. Quirke AM, Fisher BA, Kinloch AJ, Venables PJ. Citrullination of autoantigens: upstream of TNFα in the pathogenesis of rheumatoid arthritis. FEBS Lett. 2011;585(23):3681–8.

    CAS  PubMed  Google Scholar 

  51. Harvey GP, Fitzsimmons TR, Dhamarpatni AASSK, Marchant C, Haynes DR, Bartold PM. Expression of peptidylarginine deiminase-2 and -4, citrullinated proteins and anti-citrullinated protein antibodies in human gingiva. J Periodontal Res. 2013;48(2):252–61.

    CAS  PubMed  Google Scholar 

  52. Quirke AM, Lugli EB, Wegner N, Hamilton BC, Charles P, Chowdhury M, et al. Heightened immune response to autocitrullinated Porphyromonas gingivalis peptidylarginine deiminase: a potential mechanism for breaching immunologic tolerance in rheumatoid arthritis. Ann Rheum Dis. 2014;73(1):263–9.

    CAS  PubMed  Google Scholar 

  53. Laugisch O, Wong A, Sroka A, Kantyka T, Koziel J, Neuhaus K, et al. Citrullination in the periodontium - a possible link between periodontitis and rheumatoid arthritis. Clin Oral Investig. 2016;20(4):675–83.

    PubMed  Google Scholar 

  54. Tolo K, Jorkjend L. Serum antibodies and loss of periodontal bone in patients with rheumatoid arthritis. J Clin Periodontol. 1990;17:288–91.

    CAS  PubMed  Google Scholar 

  55. Risheim H, Kjaerheim V, Arneberg P. Improvement of oral hygiene in patients with rheumatoid arthritis. Scand J Dent Res. 1992;100(3):172–5.

    CAS  PubMed  Google Scholar 

  56. Khare N, Vanza B, Sagar D, Saurav K, Chauhan R, Mishra S. Nonsurgical periodontal therapy decreases the severity of rheumatoid arthritis: a case-control study. J Contemp Dent Pract. 2016;17(6):484–8.

    PubMed  Google Scholar 

  57. Romero-Sanchez C, Rodriguez C, Santos-Moreno P, Mesa AM, Lafaurie GI, Giraldo S, et al. Is the treatment with biological or non-biological DMARDS a modifier of periodontal condition in patients with rheumatoid arthritis? Curr Rheumatol Rev. 2017;13(2):139–51.

    CAS  PubMed  Google Scholar 

  58. Kirchner A, Jäger J, Krohn-Grimberghe B, Patschan S, Kottmann T, Schmalz G, et al. Active matrix metalloproteinase-8 and periodontal bacteria depending on periodontal status in patients with rheumatoid arthritis. J Periodontal Res. 2017;52(4):745–54.

    CAS  PubMed  Google Scholar 

  59. Mikuls TR, Payne JB, Yu F, Thiele GM, Reynolds RJ, Cannon GW, et al. Periodontitis and Porphyromonas gingivalis in patients with rheumatoid arthritis. Arthritis Rheum. 2014;66(5):1090–100.

    Google Scholar 

  60. Seror R, Le Gall-David S, Bonnaure-Mallet M, Schaeverbeke T, Cantagrel A, Minet J, et al. Association of anti-Porphyromonas gingivalis antibody titers with nonsmoking status in early rheumatoid arthritis: results from the prospective French cohort of patients with early rheumatoid arthritis. Arthritis Rheumatol. 2015;67(7):1729–37.

    CAS  PubMed  Google Scholar 

  61. Silosi I, Cojocaru M, Foia L, Boldeanu MV, Petrescu F, Surlin P, et al. Significance of circulating and crevicular matrix metalloproteinase-9 in rheumatoid arthritis- chronic periodontitis association. J Immunol Res. 2015;2015:1–6.

    Google Scholar 

  62. Kurgan Ş, Fentoğlu O, Önder C, Serdar M, Eser F, Tatakis DN, et al. The effects of periodontal therapy on gingival crevicular fluid matrix metalloproteinase-8, interleukin-6 and prostaglandin E2 levels in patients with rheumatoid arthritis. J Periodontal Res. 2016;51(5):586–955.

    CAS  PubMed  Google Scholar 

  63. Kharlamova N, Jiang X, Sherina N, Potempa B, Israelsson L, Quirke AM, et al. Antibodies to Porphyromonas gingivalis indicate interaction between oral infection, smoking, and risk genes in rheumatoid arthritis etiology. Arthritis Rheum. 2016;68(3):604–13.

    CAS  Google Scholar 

  64. Mercado F, Marshall RI, Klestov AC, Bartold PM. Is there a relationship between rheumatoid arthritis and periodontal disease? J Clin Periodontol. 2000;127:267–72.

    Google Scholar 

  65. Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001;72(6):779–87.

    CAS  PubMed  Google Scholar 

  66. Ramamurthy NS, Greenwald RA, Celiker MY, Shi EY. Experimental arthritis in rats induces biomarkers of periodontitis which are ameliorated by gene therapy with tissue inhibitor of matrix metalloproteinases. J Periodontol. 2005;76(2):229–33.

    CAS  PubMed  Google Scholar 

  67. Lipsky PE. Rheumatoid arthritis. In: Wilson JD, Braunwald E, Isselbacher KJ, et al., editors. Harrison’s principles of internal medicine. 12th ed. New York: McGraw- Hill; 1991. p. 1437–43.

    Google Scholar 

  68. Williams RC, Jeffcoat MK, Howell TH. Altering the progression of human alveolar bone loss with the non-steroidal anti-inflammatory drug flurbiprofen. J Periodontol. 1989;60(9):485–90.

    CAS  PubMed  Google Scholar 

  69. Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, et al. Rheumatoid arthritis: a brief overview of the treatment. Med Princ Pract. 2018;27(6):501–7.

    PubMed  PubMed Central  Google Scholar 

  70. Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Gracia JMA, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis. 2017;76(6):948–59.

    PubMed  Google Scholar 

  71. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.

    PubMed  PubMed Central  Google Scholar 

  72. Novak MJ, Polson AM, Freeman E. Effects of gold salts on experimental periodontitis. I. Histometric evaluation of periodontal destruction. J Periodontol. 1984;55(2):69–77.

    CAS  PubMed  Google Scholar 

  73. Rein P, Mueller RB. Treatment with biologicals in rheumatoid arthritis: an overview. Rheumatol Ther. 2017;4:247–61.

    PubMed  PubMed Central  Google Scholar 

  74. Tovey MG, Lallemand C. Immunogenicity and other problems associated with the use of biopharmaceuticals. Ther Adv Drug Saf. 2011;2(3):113–28.

    PubMed  PubMed Central  Google Scholar 

  75. Elliott JR, Paulsen GA, Mallek JA, et al. Treatment of early sero-positive rheumatoid arthritis: doxycycline with methotrexate versus methotrexate alone. Arthritis Rheum. 2003;48:S654.

    Google Scholar 

  76. Gay RD, Clarke AW, Elgundi Z, Domagala T, Simpson RJ, Le NB, et al. Anti-TNFα domain antibody construct CEP-37247: full antibody functionality at half the size. MAbs. 2010;2(6):625–38.

    PubMed  PubMed Central  Google Scholar 

  77. Lis K, Kuzawińskaan O, Iskra EB. Tumor necrosis factor inhibitors - state of knowledge. Arch Med Sci. 2014;10(6):1175–85.

    PubMed  PubMed Central  Google Scholar 

  78. Perpétuo IP, Caetano-Lopes J, Rodrigues AM, Marques RM, Ponte C, Canhão H, et al. Effect of tumor necrosis factor inhibitor therapy on osteoclasts precursors in rheumatoid arthritis. Biomed Res Int. 2017;2017:1–10.

    Google Scholar 

  79. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116(7):1254–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  80. Curtis JR, Singh JA. The use of biologics in rheumatoid arthritis: current and emerging paradigms of care. Clin Ther. 2011;33(6):679–707.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Mok CC. Rituximab for the treatment of rheumatoid arthritis: an update. Drug Des Devel Ther. 2014;8:87–100.

    Google Scholar 

  82. Emer JJ, Claire W. Rituximab: a review of dermatological applications. J Clin Aesthet Dermatol. 2009;2(5):29–37.

    PubMed  PubMed Central  Google Scholar 

  83. Rosman Z, Shoenfeld Y, Goddard GZ. Biologic therapy for autoimmune diseases: an update. BMC Med. 2013;11(1):88.

    CAS  PubMed  PubMed Central  Google Scholar 

  84. Gómez-Gómez GJ, Masedo A, Yela C, Martínez-Montiel MDP, et al. Current stage in inflammatory bowel disease: what is next? World J Gastroenterol. 2015;21(40):11282–303.

    PubMed  PubMed Central  Google Scholar 

  85. Hodge JA, Kawabata TT, Krishnaswami S, Clark JD, Telliez JB, Dowty ME, et al. The mechanism of action of tofacitinib - an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(2):318–28.

    PubMed  Google Scholar 

  86. Cada DJ, Demaris K, Levien TL, Baker DE. Tofacitinib. Hosp Pharm. 2013;48(5):413–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Golub LM, McNamara TF, D’Angelo G, Greenwald RA, Ramamurthy NS. A non-antibacterial chemically modified tetracycline inhibits mammalian collagenase activity. J Dent Res. 1987;66(8):1310–4.

    CAS  PubMed  Google Scholar 

  88. Preshaw PM, Hefti AF, Novak MJ, Michalowicz BS, Pihlstrom BL, Schoor R, et al. Subantimicrobial dose doxycycline enhances the efficacy of scaling and root planing in chronic periodontitis: a multicenter trial. J Periodontol. 2004;75(8):1068–76.

    CAS  PubMed  Google Scholar 

  89. LeResche L. The role of stress in inflammatory disease, including periodontal disease: review of concepts and current findings. Periodontol 2000. 2002;30:91–103.

    PubMed  Google Scholar 

  90. Assuma R, Oates T, Cohran D, Amar S, Graves DT. IL-1 and TNF antagonists inhibit the inflammatory response and bone loss in experimental periodontitis. J Immunol. 1998;160:403–9.

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors express their thanks to the research team from the Department of Periodontics, Dr. HSRSM’s Dental College and Hospital, Hingoli, Maharashtra, India, for their support during data collection and manuscript preparation.

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Correspondence to Namrata S. Jajoo.

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Jajoo, N.S., Shelke, A.U. & Bajaj, R.S. Periodontitis and Rheumatoid Arthritis: the Common Thread. Clinic Rev Bone Miner Metab 18, 18–30 (2020). https://doi.org/10.1007/s12018-020-09271-6

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