Rheumatoid arthritis

Name : Beh Hui Ying (3)

ID: D20101119
 What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic, progressive, and disabling

autoimmune disease which causes inflammation, swelling, and pain
in and around the joints.
 Signs and symptoms
Tender, warm, pain, swollen joints
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite

• Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your
fingers to your hands and your toes to your feet.

• As the disease progresses, symptoms often spread to the wrist, knee, ankle, elbow, hip and shoulder joints.
In most cases, symptoms occur in the same joints on both sides of your body.
Joint deformity in the fingers Joint deformity in the toes

Rheumatoid nodules Knee deformity

 Causes
Rheumatoid arthritis is an autoimmune disease. Normally, the immune system fights
invaders like bacteria and viruses. In the case of rheumatoid arthritis, the immune system
mistakes the healthy body’s tissues as foreign invaders and releases inflammatory
chemicals that attack the synovium.

To date, no one knows what starts this disease but according to the Genetics Home
Reference, some people appear to have genetic factors that make it more likely to suffer
from this disease. This gene is not the direct cause of the disease, but certain bacteria or
virus can trigger rheumatoid arthritis in people who have this genetic feature.
The link between rheumatoid arthritis and oral health

• Directly related to rheumatoid arthritis:

• periodontal disease

• jaw problems

• dry mouth

• Indirectly related to rheumatoid arthritis:

• Oral bacterial or viral infection
 Periodontal disease
• Rheumatoid arthritis patients are 4 times more likely to have gum disease than people without RA, and their gum disease tends to be more
severe.

• A study from Johns Hopkins Arthritis Center found that out of 100 RA patients, 70% of them had at least moderate gum disease. 

• Porphyromonas gingivalis, one of the main bacteria responsible for gum disease is also a known contributor to the onset of rheumatoid
arthritis. In fact, presence of P. gingivalis can lead to earlier onset, faster progression and greater severity of rheumatoid arthritis,
including increased damage to bone and cartilage.

• Gum disease symptoms are associated with increasing RA activity; patients with more bleeding and swelling tend to have higher levels of
RA disease activity.

• Untreated periodontal disease may also make certain RA medications less effective.
 Temporomandibular joint

• RA can affect the size of the jaw and patients may experience problems with the
temporomandibular joint which is similar to other joint problems in RA.

• It is estimated that in more than 17% of patients with RA, their TMJ are affected; commonly
resulting in pain, swelling and limited movement of the joint. The patient can feel extreme pain
while opening and closing his mouth.
 Dry mouth

• Some people with RA also develop Sjogren’s syndrome.

• It is an autoimmune condition in which a person’s immune system attacks the salivary and
lacrimal glands which leads to dry mouth and dry eyes.

• Saliva plays an important role in preventing cavities by protecting enamel from bacterial acids, so
a reduced salivary flow due to Sjögren’s syndrome also increases the risk of dental caries.
 Oral infections
•As RA is treated by suppressing the immune system with immunosuppressant drugs, the patient has
a higher chance of having infections than others.

• In the mouth, these include 

• oral thrush : a yeast infection which gives white patches, most commonly on the tongue, which
can be rubbed off to reveal a sore red patch and are possibly accompanied by an unpleasant
taste, soreness/burning sensation of the tongue and difficulty in swallowing
• cold sores on the lips : caused by reactivation of the herpes simplex virus

Oral thrush Cold sores

 Treatment
1. Disease-modifying antirheumatic drugs (DMARDs)
• They are the primary treatment for RA as they can slow the progression of the RA and prevent permanent damage to
the joints and other tissues by interfering with the overactive immune system.

• The examples of DMARD are methotrexate, hydroxychloroquine, sulfasalazine, leflunomide.

2. Biologic treatments
• Biologic treatments, such as tumour necrosis factor-alpha (TNF-alpha) inhibitors can change how the immune
system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory
substance. TNF-alpha inhibitors suppress this substance and help to prevent inflammation.

• TNF-alpha inhibitors can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an
improvement 2 weeks after starting the treatment.

• Examples include Etanercept and infliximab.

3. Physiotherapy
• For people with RA, physiotherapy may be used together with medical management. This may include
cold and heat application, electronic stimulation and hydrotherapy.

4. Surgery
• Especially for affected fingers, hands and wrists, surgery may be needed to reduce pain, repair damaged
joint and correct deformities when drug treatment has failed.
• Severely affected joints may require joint replacement surgery like knee replacement.
 References
• B. Spriggs, B. (2021, May 19). Rheumatoid arthritis (RA): Symptoms, causes, and complications. Medical News Today.
https://www.medicalnewstoday.com/articles/323361
• Mayo Foundation for Medical Education and Research. (2021, May 18). Rheumatoid arthritis. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
• Centers for Disease Control and Prevention. (2020, July 27). Rheumatoid Arthritis (RA). Centers for Disease Control and Prevention.
https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
• Wikimedia Foundation. (2021, June 17). Rheumatoid arthritis. Wikipedia. https://en.wikipedia.org/wiki/Rheumatoid_arthritis
• William C. Shiel Jr., M. D. (2021, June 4). Rheumatoid Arthritis Symptoms, Treatment, Diagnosis, Definition, Diet & Causes. MedicineNet.
https://www.medicinenet.com/rheumatoid_arthritis/article.htm
• Rheumatoid Arthritis: Causes, Symptoms, Treatments. (n.d.). https://www.arthritis.org/diseases/rheumatoid-arthritis
• Delta Dental. (2017, July). The link between rheumatoid arthritis and oral health. https://www.deltadentalins.com/oral_health/rheumatoid-arthritis.html
• National Rheumatoid Arthritis Society. (2020, December 10). Gum Disease link to rheumatoid arthritis (RA). NRAS.
https://nras.org.uk/resource/gum-disease/#anchor2
• Team, the H. E. (2020, August 6). Everything You Want to Know About Rheumatoid Arthritis. Healthline.
https://www.healthline.com/health/rheumatoid-arthritis#medications
• Eustice, C. (2020, October 17). Are Rheumatoid Arthritis Patients More Susceptible to Periodontal Disease? Verywell Health.
https://www.verywellhealth.com/periodontal-disease-rheumatoid-arthritis-190332
• Center, A. (2020, February 12). Dental Tips for the Rheumatoid Arthritis Patient • Johns Hopkins Arthritis Center. Johns Hopkins Arthritis Center.
https://www.hopkinsarthritis.org/arthritis-news/5-dental-tips-for-the-ra-patient/
• Ellis, S. (2020, July 28). The Connection Between Rheumatoid Arthritis and Dental Health.
https://www.healthcentral.com/slideshow/link-between-dental-health-and-rheumatoid-arthritis