title: Gingivitis and periodontitis are related to repeated high levels of circulating tumor necrosis factor-alpha in patients with rheumatoid arthritis.
abstract: BACKGROUND
  Several studies have indicated a relationship between rheumatoid arthritis and periodontal disease. The aim of this study was to investigate the association between the circulating proinflammatory mediators tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta, prostaglandin E(2), serotonin, rheumatoid factor, and periodontitis in patients with rheumatoid arthritis.
  
  
  METHODS
  Nineteen patients, 17 women and two men, with rheumatoid arthritis were included. These patients had been examined repeatedly (average of three times) with regard to inflammatory markers and mediators from blood samples. Their teeth, excluding third molars, were examined with regard to number, clinical attachment level (CAL), probing depth (PD), and gingival bleeding on probing (BOP). Assessment of furcation involvement and increased tooth mobility was also made. All patients were non-smokers. Thirty healthy individuals, 20 women and 10 men, were included as a reference regarding TNF-alpha.
  
  
  RESULTS
  Patients with high levels of time-averaged TNF-alpha from repeated plasma samples had a higher frequency of BOP as well as increased CAL and PD compared to those with low levels.
  
  
  CONCLUSIONS
  Gingivitis and periodontitis are related to high levels of circulating TNF-alpha in patients with rheumatoid arthritis.
authors.affiliation: Department of Clinical Oral Physiology, Karolinska Institute, Huddinge, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Nilsson
authors.forename: Sigvard
authors.initials: S
authors.lastname: Kopp
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood*; D001792:Blood Platelets / Q000473:pathology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015232:Dinoprostone / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000097:blood / Q000150:complications; D005884:Gingival Hemorrhage / Q000097:blood / Q000150:complications; D005891:Gingivitis / Q000097:blood / Q000150:complications*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000097:blood / Q000150:complications; D010514:Periodontal Pocket / Q000097:blood / Q000150:complications; D010518:Periodontitis / Q000097:blood / Q000150:complications*; D012217:Rheumatoid Factor / Q000097:blood; D012701:Serotonin / Q000097:blood; D014086:Tooth Mobility / Q000097:blood / Q000150:complications; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D018836:Inflammation Mediators; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D012701:Serotonin; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D015232:Dinoprostone