SYSTEMIC DISEASES (M BARTOLD, SECTION EDITOR) The Link Between Periodontitis and Rheumatoid Arthritis: A Periodontist’s Perspective

# The Author(s) 2014. This article is published with open access at Springerlink.com Abstract In this review, we critically evaluate the case–con-trol studies examining the relationship between rheumatoid arthritis (RA) and periodontitis, two common chronic inflam-matory diseases with a similar host-mediated pathogenesis. We review the “two-hit ” periodontitis model that our group previously proposed, in which we elucidate how a systemic disease such as RA can potentially exacerbate or initiate periodontitis. Furthermore, we discuss adjunctive host modulation therapy, originally developed for periodontitis (i.e., subantimicrobial-dose doxycycline alone or in combina-tion with an anti-inflammatory agent), to simultaneously mit-igate RA and periodontitis. Finally, we review studies describ-ing periodontal treatment effects on both RA disease activity measures and systemic inflammation. Current evidence sug-gests that an association exists between periodontitis and RA. Well-designedmulticenter longitudinal clinical trials and stud-ies with sufficient sample sizes are needed to ascertain the temporal relationship between these two diseases and whether periodontal treatment can reduce the severity of RA or prevent its onset