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Vitamins C and D and Gingival Disease in Rheumatoid Arthritis

3/13/2018 5:00:42 PM
Rheumatoid arthritis (RA) and gingival disease both involve immune dysregulation and chronic inflammation. Gingival disease is associated with Porphyromonas gingivalis, an oral pathogen which expresses an enzyme that catalyzes the citrullination of arginine. Antibodies to this and other citrullinated antigens are found in circulation in individuals with gingival disease. RA is characterized by the presence of antibodies to human citrullinated alpha-enolase, which cross-react with antibodies produced in response to the primary oral pathogen of gingival disease—Porphyromonas gingivalis. Some studies show that the prevalence of gingival disease is higher in patients with RA than in the general population.
A retrospective analysis of data from the National Nutrition and Health Examination Survey (NHANES) aimed to identify environmental factors associated with both RA and gingival disease and to investigate factors that might protect against gingival disease in patients with RA. All participants completed an interview and exam between 1999 and 2004. The final analysis was based on 754 patients with RA, including 173 (23%) with gingival disease.
The odds of gingival disease were significantly decreased in patients younger than age 60 (OR=0.53; p=.02), those with higher vitamin C intake (OR=0.996; p=.04), those with higher serum vitamin D levels (OR=.097; p=.01), those with higher serum beta-cryptoxanthin (OR=0.94; p=.015), and those who were nonsmokers (OR=0.49; p=.004). The odds of gingival disease were significantly increased in men (OR=1.5; p=.05), non-Hispanic blacks (OR=1.87; p=.03), and those with increased serum vitamin E levels (OR=1.002; p=.05).
Limitations of this study were that it was a cross-sectional design and it relied on information from self-reported questionnaires. Still, the study provides useful information related to the risk factors and protective factors for gingival disease in RA. Overall, the results suggest that patients with RA at the highest risk for gingival disease are men over the age of 60, smokers, those with low intake of vitamin C, and those with low serum levels of vitamin D. Thus, increased vitamin C and D may improve the management of periodontal disease in patients with RA. Whether this would, in turn, impact the symptomatology of RA is unknown.
Huang LG, Chen G, Chen DY, Chen HH. Factors associated with the risk of gingival disease in patients with rheumatoid arthritis. PLoS One. 2017;12 (10):e0186346