title: Hypothesis: the humoral immune response to oral bacteria provides a stimulus for the development of rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) and adult periodontitis share common pathogenetic mechanisms and immunologic and pathological findings. One oral pathogen strongly implicated in the pathogenesis of periodontal disease, Porphyromonas gingivalis, possesses a unique microbial enzyme, peptidylarginine deiminase (PAD), the human equivalent of which has been identified as a susceptibility factor for RA. We suggest that individuals predisposed to periodontal infection are exposed to antigens generated by PAD, with de-iminated fibrin as a likely candidate, which become systemic immunogens and lead to intraarticular inflammation. PAD engendered antigens lead to production of rheumatoid factor-containing immune complexes and provoke local inflammation, both in gingiva and synovium via Fc and C5a receptors.
authors.affiliation: Center for Rheumatic and Autoimmune Diseases, Livingston, New Jersey 07039, USA. Erostein@sbhcs.com
authors.forename: Elliot D
authors.initials: ED
authors.lastname: Rosenstein
authors.forename: Robert A
authors.initials: RA
authors.lastname: Greenwald
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Kushner
authors.forename: Gerald
authors.initials: G
authors.lastname: Weissmann
mesh_terms: D000328:Adult; D000917:Antibody Formation / Q000235:genetics / Q000276:immunology*; D001172:Arthritis, Rheumatoid / Q000209:etiology* / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D004198:Disease Susceptibility / Q000209:etiology / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D006867:Hydrolases / Q000276:immunology / Q000378:metabolism; D008954:Models, Biological; D009061:Mouth Mucosa / Q000382:microbiology*; D010518:Periodontitis / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D016966:Porphyromonas gingivalis / Q000201:enzymology* / Q000472:pathogenicity; D000076342:Protein-Arginine Deiminases; D012217:Rheumatoid Factor / Q000096:biosynthesis / Q000276:immunology; D013583:Synovial Membrane / Q000276:immunology
chemical_list: D012217:Rheumatoid Factor; D006867:Hydrolases; D000076342:Protein-Arginine Deiminases