RELATED: New Medication Guidelines for Treating Rheumatoid Arthritis Previewed At this point, experts aren’t sure which health issue is the chicken and which is the egg. Back in 2008, German research published in the Journal of Periodontology showed that people with RA had 8 times the odds of developing gum disease as compared with people without RA. And study after study has brought more clarity to the connection. Research from the University of Louisville in Kentucky published in September 2013 in the journal PLoS Pathogens found that the bacterium that causes periodontal disease, Porphyromonas gingivalis, increases the severity of rheumatoid arthritis, leads to an earlier onset of the disease, and causes symptoms to progress more quickly. RELATED: Heart Disease Often Missed in Rheumatoid Arthritis In a meta-analysis of 21 published studies on the topic in Frontiers in Immunology, periodontitis was 13 percent more common in RA patients than in a control group of people who did not have the disease. “The connection can be confusing,” says Terrance Griffin, DMD, chair of the department of periodontology at the Tufts University School of Dental Medicine in Boston. “There are so many factors that can come into play, like oral hygiene. RA can cause you to lose some dexterity, which may mean you can’t clean your teeth as well. But that may only partially account for this relationship.” RELATED: Rheumatoid Arthritis and You: What RA Can Do to Your Body

Heart Health Relates to Gum Health and RA

And now, a study published in Arthritis and Rheumatology in November 2020 found that the connection between gum disease and RA has another unfortunate side effect: It increases the risk of cardiovascular disease. Researchers from Columbia University found that immune system responses to bacteria that cause periodontal disease, particularly Aggregatibacter actinomycetemcomitans, may be a reason why people with RA are at greater risk for heart disease. Speaking about their research, the study authors wrote, patients with “RA may represent a population in which the effect of periodontal pathogens on atherogenesis [arterial plaque] is heightened.” RELATED: Rheumatoid Arthritis Complications

It’s on You to Stay on Top of Your Heart Health

Despite the higher risk, there are no firmly established guidelines for cardiovascular screening for people with RA. “An awareness of a higher risk of cardiovascular disease is important, and usual screening for CVD is advised, but there are no current recommendations that all RA patients should have specific CVD testing guided by a cardiologist,” says lead study author Jon T. Giles, MD, associate professor of medicine at Columbia University in New York City.

Doctors may not know for sure how gum disease and RA are linked, but both diseases have inflammation in common, which may explain the connection. Inflammation is a protective immune system response to foreign bodies like viruses and bacteria. But with autoimmune diseases like rheumatoid arthritis, the immune system mistakenly triggers inflammation even though there are no viruses or bacteria to fight off, says Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School and attending physician at Texas Health Presbyterian Hospital in Dallas. Dr. Zashin says it’s possible that the immune system is stimulated by mouth inflammation and infection, “setting off a cascade of events where inflammation develops at the site of joints or arthritis.” He says controlling the inflammation through better dental care could play a role in reducing the incidence and severity of RA. RELATED: How to Sleep Well Despite Rheumatoid Arthritis

Treating One Condition May Improve the Other

Researchers at Case Western University found that when people with a severe form of rheumatoid arthritis successfully treated their gum disease, their pain and other arthritis symptoms got better. Patients who were treated with drugs for both gum disease and rheumatoid arthritis fared better than those who received RA medication alone. “People who have both gum disease and RA should have an informed care team comprised of both a physician and a periodontist,” says Dr. Griffin. “Brushing and flossing can be challenging for those with RA, and you should work with your doctors to find out what works best for you. And if you don’t have a periodontist, get an evaluation from your dentist every year to monitor the status of your gums, since you are more likely to get it.” RELATED: Arthritis Lifestyle Types: Which One Are You?

Smart Dental Care for People With Rheumatoid Arthritis

Gum disease ranges from gingivitis, a mild form that causes swollen, tender gums, to more serious forms like periodontitis, in which inflammation affects the tissue and bone supporting the teeth. Some people with RA also develop Sjögren’s syndrome or sicca syndrome, an autoimmune disease of the glands, which causes dry mouth and increased tooth decay. If you have gingivitis, it can be reversed with twice-yearly dental cleanings and good at-home care. Here are some other tips form the American Dental Association to make dental care easier to manage:

See a dentist regularly. A professional will be able to spot signs of trouble and refer you to a periodontist if your gums need extra care. As we age, we’re more likely to have receding gums, which exposes the roots and increases risk of tooth decay.Reinvent your toothbrush. To better handle your brush, add a tennis ball or bicycle grip to the end. And electric toothbrushes may be easier to hold than a traditional one, since they have a wider handle. You should brush your teeth twice a day with a soft toothbrush along the gum line and use a toothpaste that contains fluoride.Take out your dentures before you go to sleep. Ask your dentist how to care for them.Experiment with new types of floss. If holding onto that tiny thread is a struggle, try floss holders, floss picks, or threaders instead.“Pump up” your paste. Toothpaste in a pump might be easier for you to use than a tube you have to squeeze.Don’t light up. Smoking is a big risk factor in developing gum disease, and it can interfere with the success of some rheumatoid arthritis treatments.