title: Could early rheumatoid arthritis resolve after periodontitis treatment only?: case report and review of the literature.
abstract: 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.
authors.affiliation: 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.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Salemi
authors.forename: Michela I
authors.initials: MI
authors.lastname: Biondo
authors.forename: Chiara
authors.initials: C
authors.lastname: Fiorentino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argento
authors.forename: Michele
authors.initials: M
authors.lastname: Paolantonio
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Murro
authors.forename: Vito A
authors.initials: VA
authors.lastname: Malagnino
authors.forename: Marco
authors.initials: M
authors.lastname: Canzoni
authors.forename: Andrea Picchianti
authors.initials: AP
authors.lastname: Diamanti
authors.forename: Raffaele
authors.initials: R
authors.lastname: D'Amelio
mesh_terms: D001172:Arthritis, Rheumatoid / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications / Q000628:therapy*