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Arthritis Research Paper

Arthritis

Disability Research Paper

Ashley McPeek

Kirkwood Community College

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Arthritis Research Paper

The term, arthritis, is derived from the Greek language; the condition is named after the

Greek word meaning “joint”. Arthritis is a chronic autoimmune disease caused by the body's

own immune system attacking itself. It leads to destruction of the body’s joints, cartilage, and

surrounding tissues. This long-term destruction can lead to physical disability (“Arthritis,” 2000).

There have been many different documentations of arthritis and related research conducted

overtime in history. There is evidence of arthritis being acknowledged and found that dates back

to the Renaissance era. There were many artists that depicted hands and wrists with deformities

in their paintings. These images are strikingly similar to the signs that are now recognized as

arthritis. Arthritis was first officially noted by modern medicine in 1800 by Augustin Jacob

Landré-Beauvais, a physician based in France. The term “arthritis” was coined later, in 1890, by

Alfred Garrod (“Arthritis,” 2000). While the first mentionings of arthritis occurred in the 1800s,

“the disease itself began having its histological and molecular characteristics investigated

systematically only from the mid-1960s onward” (“Arthritis,” 2000). Arthritis has been around

for a long time and is still a very complex condition that continues to evolve and be researched.

There are many different etiologic factors that may cause arthritis. It can be hard to depict

the exact reason someone may acquire this condition; it is thought to result from both genetic

traits, as well as environmental triggers. Environmental triggers include factors that “modify or

alter the host response”, for example, “socioeconomic status, lifestyle, diet, hormonal, and

psychological variables” (Bartold, 2018). According to Bartold, infectious agents have been

considered a potential trigger for this condition (2018). Arthritis impacts many people, and it

does not discriminate. There is no evidence that it impacts one race or ethnicity more than

another. However, it is “twice as prevalent in women than men” (“Arthritis,” 2000). There are

many different forms of arthritis. These include “calcific periarthritis, enteropathic arthritis,
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Arthritis Research Paper

chronic, gouty, hand osteoarthritis, hip and knee osteoarthritis, thumb, Jaccoud's, juvenile

osteoarthritis, oligoarthritis, polyarthritis, peripheral, psoriatic, rheumatoid, and septic

arthritis”(“Arthritis,” 2000). According to“Arthritis”, about 1% of people in the world have this

condition (2000). Typically, the onset of arthritis will begin within the ages of 40-50 years.

However, individuals of any age can be impacted by this chronic disease. Those that are younger

than the age of 30 are more likely to go into remission than patients that develop arthritis at the

age of 50 or older. Typically, the older someone is, the more active the disease presents.

(Bartold, 2018).

Arthritis is a physically debilitating disease. It does not impact intellectual ability, but it

can affect mental health, as it disrupts daily life. The disease's physical symptoms include “pain,

stiffness, decreased range of motion, and joint deformities” (“Everyday Life,” 2020). That being

said, living with arthritis comes with many challenges. People with arthritis are generally weak,

sore, and have reduced mobility. According to Everyday Life, how arthritis impacts daily life

may fluctuate (2020). Some days, those with this condition may feel okay, and other days it may

feel as if they cannot even walk or get out of bed because of the debilitating pain the destruction

of the joints causes. It can be frustrating to be unsure of how one’s own body will react on any

given day. “Everyday chores like cooking, laundry, cleaning, garden work and recreational

activities can become a challenge as the disease progresses” (“Everyday Life,” 2020).

This disease can be treated with many different drugs; however, they cannot cure this

chronic condition. It has been found that combining therapies may be the most beneficial

treatment of choice (Bullock et al., 2018). Combining drugs was found to cause more initial

remission, which can happen overtime. However, arthritis can be progressive if not controlled. It

is possible to halt the destruction of joints, and inflammation can be reduced, resulting in less
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Arthritis Research Paper

destruction from occurring. Medications will help treat symptoms of arthritis but will never cure

the source of the problem: an overactive autoimmune system. The first line of medications that

are used to manage arthritis symptoms are non-steroidal anti-inflammatory drugs and

corticosteroids. Examples of NSAID medications are Ibuprofen, Naproxen, Aspirin, and Motrin.

These medications inhibit prostaglandins, decreasing inflammation, which alleviates pressure,

soreness, swelling, and pain occurring around joints. Taking these medications for a long period

of time does come with implications. Side effects include “tinnitus, hearing loss, nausea,

abdominal pain, ulcers, and GI bleeding” (Bullock et al., 2018). Corticosteroids are typically the

next drug of choice; they are a more potent anti-inflammatory. Steroids are not supposed to be a

long-term treatment, as they have greater side effects such as “bone-thinning, weight gain,

diabetes, and immunosuppression” (Bullock et al., 2018). Because of this, they are only a

temporary solution. The second line of medications are focused on stopping further joint

destruction from occurring, and their goal is to create a state of remission for the patient. These

medications can take up to months to be effective. Examples of these drugs include

Methotrexate, Plaquenil, and Azulfidine. According to Bullock et al., “Common side effects

include problems in the GI tract, skin, and central nervous system. The eyes, in particular, can be

affected when this drug is taken at high doses. Patients on these medications require routine

consultation with an ophthalmologist” (2018). It is also important that frequent blood and urine

tests are completed to continue to evaluate the drug's effects on the kidneys and liver. Newer

medications include biologics, such as Embrel, Entyvio, and Remicade. These drugs seem to be

very specific in slowing destruction. However, they put patients at risk by lowering their

immunity, so they are more likely to have infections that are difficult to fight off. The last
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Arthritis Research Paper

treatment of choice would be surgery, which can include joint replacements or repairing tendons.

(Bullock et al., 2018).

Arthritis impacts the oral cavity in many ways. The UK performed studies on 500,000

people in Great Britain that show how a specific type of arthritis, ankylosing spondylitis, impacts

the oral cavity. The data collected proved that those with this arthritis condition had an increase

in mouth ulcers, gingival bleeding, gingival pain, and tooth ache. It is thought that there is a

direct correlation between arthritis and mouth ulcers. There was no direct relation between

arthritis and the previously mentioned symptoms. (Abbood et al., 2018). Arthritis is associated

with Temporomandibular joint dysfunction, Sjogren’s syndrome, xerostomia, and periodontal

disease as well. Temporomandibular joint dysfunction impacts how one talks, chews food, and

opens their mouth as it may cause discomfort, clicking, pain, and headaches. Sjogren’s syndrome

sometimes occurs alongside arthritis. This syndrome is characterized by the immune system

attacking the cells that produce saliva, causing a very dry mouth. (Bingham & Moni, 2013).

There may be an increase in decay incidence noted for patients that present with arthritis. This

may be because they struggle with care at home, as tooth brushing and floss can pose a great

challenge as their joints are stiff and ache. It can be difficult to use the right hygiene techniques

or even bring their hands to their mouth. Dry mouth is also typically impacted by arthritis itself

and the drugs that are taken to treat the symptoms, including NSAIDS. This dry mouth can lead

to an increase in caries, as saliva is not being produced to create a buffer between acid and tooth

structure.

Periodontal disease and arthritis have many similarities. The conditions have now been

linked and investigated throughout the years. The John Hopkins team discovered that

hypercitrullination, which regulates protein function, was overactive in both arthritis patients and
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periodontal patients, proving that the two may have a link (“Evidence suggests oral bacterium,”

2018). In both conditions, there is destruction of bone and supporting tissues. The claim that

rheumatoid arthritis is caused by “some form of infectious agent has been postulated for more

than 70 years and is still under consideration” (Bartold, 2018). It is even shown that “patients at

risk for rheumatoid arthritis (RA) demonstrate higher levels of periodontal bacteria before

evidence of the chronic inflammatory joint disease presents itself, according to research

presented at the 2018 Annual European Congress of Rheumatology in Amsterdam'' (“Periodontal

diseases may be a key initiator,” 2018). More patients with arthritis were found to have p.

gingivalis and AA than those that did not. The data describes findings as “73% versus 38%”

(“Periodontal diseases may be a key initiator,”). Gram negative bacteria may also be a factor in

the onset of arthritis, which is also known to cause periodontal disease. “Porphyromonas

gingivalis, could be the triggering factor for the autoimmunity against citrullinating proteins in

the joints, which might initiate rheumatoid arthritis” (Abbood et al., 2018).

There are also connections between treating both of these conditions. It is plausible that

anti-inflammatory drugs used for arthritis suppress the destructive immune response that impacts

oral health destruction, causing periodontal disease as well. (Hein, 2019). A study from Al-

Katma showed data suggesting controlling gingival and periodontal disease with SRP treatment

contributed to reducing the signs and symptoms of arthritis. It is thought that after this

periodontal treatment, there are less inflammatory products and bacteria in the blood, reducing

the systemic number of bacteria that may cause arthritis. (Hein, 2019).

There is potential that a caretaker may be needed for someone with arthritis. Each case is

unique in how it progresses and impacts daily living. For instance, patients with controlled

arthritis may not even notice the aches and pains. They can drive themselves with no issues, can
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do laundry, brush their teeth, and get dressed on their own. However, for some, arthritis can pose

as a disability, for example it may be difficult to turn their head in the car to check for oncoming

traffic. Some may not be able to dress themselves, or even grasp utensils to eat or cook dinner. In

this case, a caretaker would be necessary (“Everyday Life,” 2020).

Arthritis does impact oral hygiene care; fine motor skills are essential for brushing and

flossing. It is necessary to work with dental professionals to find a routine that will work for each

individual that may struggle with these skills. It may be hard to maneuver and wrap floss around

the fingers to reach the oral cavity. In this case, a floss aid with a large and long handle should be

recommended. Electric toothbrushes can improve oral hygiene, but the vibration may make it

challenging for someone with arthritis to use. A manual toothbrush with a large handle could be

used instead. You could even add a large grip onto the toothbrush handle to create a more

comfortable grip for the fingers and wrist. Patients may want to avoid scheduling their

appointments early in the morning, or late in the day. It is best to schedule their dental

appointments in the mid-day, as it is common for arthritis to cause pain in the morning. With

activity, this stiffness may improve. However, as one reaches the afternoon or evening, the body

will feel sore from prolonged activity.

Clinicians will need to modify their appointments. It may be beneficial to take multiple

breaks if a patient is sore and needs to release tension in their joints. It may also be more

comfortable for the patient to refrain from laying down, depending on what joints are causing

them pain. Laying down can be hard on the hips and spine, causing more tenderness, so working

with the patient sitting up may be helpful. (Senthelal et al., 2022).

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Overall, arthritis is a challenging condition to have. It can heavily impact oral hygiene

care, and it may even be closely related to periodontal disease. Information will continue to

evolve, linking this condition to the oral cavity as more research is conducted.
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References

Abbood, H. M., Pathan, E., & Cherukara, G. P. (2018). The link between ankylosing spondylitis

and oral health conditions: Two nested case-control studies using data of the UK Biobank.

Journal of Applied Oral Science, 27.

Arthritis. (2000). Nature Biotechnology, 18.

Bartold, M. P. (2018). Investigating the link between rheumatoid arthritis and periodontal

diseases. Dimensions of Dental Hygiene, 12, 51-54.

Bingham, C. O., & Moni, M. (2013). Periodontal disease and rheumatoid arthritis. Current

Opinion in Rheumatology, 25, 345–353.

Bullock, J., Rizvi, S. A. A., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J.

(2018). Rheumatoid arthritis: A brief overview of the treatment. Medical Principles and

Practice, 27, 501–507.

Evidence suggests oral bacterium contributes to rheumatoid arthritis. Dimensions of Dental

Hygiene. (2018).

Hein, C. (2019). Exploring the relationship. Dimensions of Dental Hygiene, 6, 30-33.

Institute for Quality and Efficiency in Health Care. (2020). Everyday life with rheumatoid

arthritis. National Library of Medicine.

Periodontal diseases may be a key initiator of rheumatoid arthritis. Dimensions of Dental

Hygiene. (2018).
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Arthritis Research Paper

Senthelal, S., Li, J., Ardeshirzadeh, S., & Thomas, M. A. (2022). Arthritis. National Library of

Medicine.
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Arthritis Research Paper

Dental Hygiene IV Disabilities (Special Needs) Research Paper Criteria Sheet

64 Points Possible Due: DUE DATE: 12/01/2022

Research in depth, a disability that has oral implications. The disability can be one studied in
lecture or other DHYG courses or something you are interested in learning more about.

This research paper must be typed, double-spaced in written form. The paper should be a
minimum of 5 pages in length, with a cover page…Include rubric. Can also be sent
electronically

Site a minimum of 5 peer reviewed references. (These 5 references will be your log of literature
requirement)
Limit of 1 reference from the Internet (.org or hospital website). Source must be a professional
organization. Make sure all resources are professional and credible.

CONTENT TO INCLUDE:
Topic: Disability of choice (3 points/question) 15 POINTS
*What is the disability?
*History of disability: When was it first recognized? By whom?
*Predisposing factors of the disability. (Congenital, acquired)
*Whom does the disability effect? (Male/female, ethnicity?)
*When is population effected?

Effects on the body (3 points/question) 15 POINTS

*How does the disability affect the body physically?
*Are there intellectual concerns that effect the disability?
*Medications prescribed to help disease or symptoms.
*Do medications adversely affect the body (physically or intellectually)?
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Arthritis Research Paper

*Is the disease progressive, does it have a state of remission, is it a lifelong condition?

Effects on the oral cavity (3points/question) 12 POINTS

*How does the disability affect the oral cavity physically?
*Incidence of decay due to disability.
*Incidence of periodontal disease, alignment, malformation considerations.
*Medications effect on the oral cavity (xerostomia, dysplasia etc.)

Dental Treatment/appointment modifications (3 points/question) 12 POINTS

*Is there a need for caretaker? Discuss why or why not.
*Tooth brush modifications (Large handle, power brush etc.)
*Dental aides (floss holder, special brushes etc)
*Appointment modifications (OHI concerns, operator or patient positioning etc.)

Format of paper 10 POINTS

*Spelling (2 points)
*Grammar (2 points)
*Bibliography format (2 points)
*Sources cited correctly in paper (2 points)
*Required length, 5 pages (2 points)

References
See APA style research paper references