Salemi Simonetta, Biondo Michela I, Fiorentino Chiara, Argento Giuseppe, Paolantonio Michele, Di Murro Carlo, Malagnino Vito A, Canzoni Marco, Diamanti Andrea Picchianti, D'Amelio Raffaele
From the Division of Allergy, Clinical Immunology and Rheumatology (SS, MIB, CF, MC, APD, RD); Division of Radiology (GA), S. Andrea University Hospital, Sapienza University of Rome, Rome; Department of Periodontology (MP, CDM), G. D'Annunzio University; and Department of Endodontics (VAM), G. D'Annunzio University, Chieti-Pescara, Italy.
Medicine (Baltimore). 2014 Dec;93(27):e195. doi: 10.1097/MD.0000000000000195.
Rheumatoid arthritis (RA) is an immune-mediated polyarthritis; currently no pathogenic agent has been identified as a disease trigger. A patient with RA, presumably caused by periodontal infection, whose remission has been observed after periodontitis treatment in absence of specific RA therapy, is reported here for the first time, to our knowledge. A 61-year-old male patient presented migrant arthritis associated with antibodies against citrullinated protein antigens positivity. The clinical features allowed to make RA diagnosis according to the 2010 European League against Rheumatism/American College of Rheumatology RA classification criteria. X-ray of the second upper molar showed chronic apical periodontitis. After its treatment, arthritis remission has been observed in the absence of specific RA therapy. It has been suggested that periodontitis may have a trigger role in RA pathogenesis. This could be explained by the enzymatic action of Porphyromonas gingivalis, probably leading to break tolerance to collagen. The identification and subsequent treatment of periodontitis should therefore be considered pivotal in RA prophylaxis and management.
类风湿关节炎（RA）是一种免疫介导的多关节炎；目前尚未确定任何病原体可作为疾病触发因素。据我们所知，本文首次报道了一名可能由牙周感染引起的RA患者，在未进行特异性RA治疗的情况下，牙周炎治疗后病情缓解。一名61岁男性患者出现与抗瓜氨酸化蛋白抗原抗体阳性相关的游走性关节炎。根据2010年欧洲抗风湿病联盟/美国风湿病学会RA分类标准，其临床特征支持RA诊断。上颌第二磨牙X线片显示慢性根尖周炎。治疗后，在未进行特异性RA治疗的情况下观察到关节炎缓解。有人提出，牙周炎可能在RA发病机制中起触发作用。这可以通过牙龈卟啉单胞菌的酶促作用来解释，可能导致对胶原蛋白的耐受性破坏。因此，牙周炎的识别和后续治疗应被视为RA预防和管理的关键。
