Association of oral inflammation and symptoms of active rheumatoid arthritis

Objective: Case report presents dental treatment of oral inflammation and subsequent reduction of symptoms of active rheumatoid arthritis (RA). Methods: Male Patient was diagnosed with highly active anti-CCP-negative RA in 2010-06. He reported morning stiffness and pain in fingers, hip and shoulders. Finger joints were swollen. Health-assessment-questionaire (HAQ) score was 1.25. Oral Medication was a nonsteroidal-anti-inflammatory-drug (Diclofenac 50mg once a day) and an opioid (Tramadol 100mg once per night). Dental evidence showed intact restorations but swollen, oedematous gingiva. All teeth were sensitive except for maxillary-left-first-premolar (24). Vestibular palpitation and percussion on 24 were painful. Radiographic examination revealed a distinct apical translucency on 24. Oral hygiene indices recorded were Plaque-Control-Record (PCR): 52% and Gingival-Bleeding-Index (GBI): 13%. Mean Pocket-Probing-Depth (PPD) value was 3.2mm, mean Clinical-Attachment-Level (CAL) value was 3.3mm. The Patient was diagnosed a generalized mild, localized moderate chronic periodontitis and apical periodontitis of 24. Results: The Patient underwent professional tooth cleaning (PTC) and oral hygiene instruction. Oral hygiene indices reduced to PCR: 11% and GBI: 0%. HAQ score reduced to 0.0. Tooth 24 was endodontically treated (mechanical instrumentation, irrigation with chlorhexidine (0.2%) and sodium hypochlorite (2.5%), temporary root canal filling with calcium hydroxide). After 2 weeks palpitation and percussion on 24 were not painful anymore. Patient reported that since dental therapy he was free of pain in the oral cavity and that his rheumatoid complaints had decreased. Therefore, he had reduced his medication to Diclofenac 50mg once a week and he had stopped the use of Tramadol. Conclusion: Oral inflammations influence the manifestation of rheumatoid arthritis. Elimination of triggers in oral cavity contributes to a reduction in signs and symptoms of active RA. This case report supports the association between inflammatory processes in the oral cavity and rheumatoid arthritis.