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Arthritis and periodontal disease are generally not thought of as occurring together. We generally think of these inflammatory diseases individually, without much thought as to how they are affected by other diseases or how they may exacerbate disease in the body.

Rheumatoid arthritis is an autoimmune inflammatory disease in which our own cells attack the joints. The disease causes inflammation, pain and stiffness. This can progress to severe bone damage, causing  a disability of the affected joints.

Periodontal disease is a chronic inflammatory disease caused by bacteria that trigger an inflammation of the gums. Further breakdown is caused by our own cells in defense against the periodontal bacteria..

In separate studies, researchers have found a two-way relationship between these two conditions where rheumatoid arthritis patients face higher risks of developing gum disease and periodontal disease patients have increased risk of rheumatoid arthritis.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.  The cause of Rheumatoid Arthritis is not known. It is classified as an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue. It can occur at any age, but is more common in middle age. Women get rheumatoid arthritis more often than men.

The symptoms can include:

-Morning stiffness, lasting longer than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour or so.

-Joint pain is usually felt on the same joint on both sides of the body.

-Over time, joints may lose their range of motion and may become deformed.

Other symptoms include:

-Chest pain when taking a breath (pleurisy).

-Dry eyes and mouth (Sjogren syndrome).

-Eye burning, itchy eyes, and discharge from eyes.

-Nodules under the skin (usually a sign of more severe disease process).

-Numbness, tingling, or burning in the hands and feet.

-Difficulty sleeping.

Periodontal Disease and Arthritis Link

There is a high incidence of periodontal disease in patients with rheumatoid arthritis. The link between the two can include:

Periodontal disease and rheumatoid arthritis both occur as a result of  chronic inflammatory responses by the body. This leads to destruction of supporting tissues and bone.

-They have similar characteristics, risk factors, and pathological processes. Smoking is a common risk factor between rheumatoid arthritis and periodontal disease. Smoking causes both conditions to worsen.

-When a patient has both rheumatoid arthritis and periodontal disease, they have more anti-citrullinated protein antibodies (ACPA), which cause even more inflammation in the gums and other parts of the body, making all inflammatory conditions worsen . ACPA increases rheumatoid arthritis disease activity and the level of inflammatory markers.

-research studies have found that patients with both periodontal disease and rheumatoid arhtritis  have  experienced decreased pain, swelling and stiffness after periodontal gum treatments.

-Periodontal disease is responsible for chronic inflammation in the mouth, which can trigger chronic inflammation in other parts of the body, including the joints.

How Does Periodontal Disease Trigger Rheumatoid Arthritis?

Periodontal disease can set off  rheumatoid arthritis in many ways:

-The bacteria causing periodontal disease enters the blood stream and settles in the synovial fluid that lubricates the joints triggering inflammation in the joints.

-research studies have established that periodontal disease may decrease the effectiveness of tumor necrosis factor inhibitor treatment for rheumatoid arthritis. This makes it harder to treat rheumatoid arthritis using this treatment in patients with periodontal disease.

-The inflammation caused by the periodontal disease causing bacteria can raise the level of cytokines, which promote the release of CRP from the liver and result in systematic inflammation in the whole body, causing inflammatory conditions such as rheumatoid arthritis.

-Treatment of periodontal disease decreases rheumatoid arthritis symptoms such as joint pain and inflammation.

Can Rheumatoid Arthritis Contribute to Periodontal Disease?

The following are a few ways that rheumatoid arthritis can add to periodontal disease:

-Generally, symptoms from periodontal disease are more severe in patients with rheumatoid arthritis. For example, they have deeper periodontal pockets between the teeth and gums, making it easier to develop infections.Rheumatoid arthritis sufferers are faced with an increased risk of developing periodontal disease and severe jawbone loss.

-While both conditions stem from a chronic inflammatory response and weakened immune system, rheumatoid arthritis damages hand dexterity function, making it hard for patients to take proper care of their teeth using regular dental hygiene techniques. This not only increases the chance of developing new gum problems, but also makes existing gum problems much worse.

-Rheumatoid arthritis increases the risk of developing periodontal problems since alveolar bone loss in arthritic patients is linked to decreasing periodontal health, which has a greater chance of progressing into periodontal disease.

-The bacteria that cause gum disease access the blood circulation. This makes it possible for antibiotics administered to treat arthritis to also kill gum disease bacteria. This way, treating arthritis leads to an improvement in periodontal disease and treating gum disease improves the symptoms of arthritis.


It is important to remember these two conditions do not always occur together. There are plenty of periodontal disease patients who don’t have arthritis and many patients with rheumatoid disease who have healthy gums. While it is not clear which conditions occur first, and there is no conclusive evidence that these two conditions have a connection, the awareness of the association between rheumatoid arthritis and periodontal disease makes it necessary for patients of rheumatoid arthritis to visit a dentist or periodontist for evaluations and treatment regularly. Patients of rheumatoid arthritis should also make a point of regularly practicing proper dental hygiene maintenance, including brushing and flossing.

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Fibromyalgia can be a debilitating disorder. It that can strike at any time for those affected by it. The cause of fibromyalgia is unknown at this time but it is believed to involve psychological, genetic, neurological, and environmental factors. Fibromyalgia tends to affect women at a greater rate than men (about 9 women for every 1 man affected). It is believed fibromyalgia affects between 3-4% of the population. It has also been associated with rheumatoid arthritis, lupus, and as a side effect of anticholesterol medications.

Fibromyalgia Symptoms

-Pain. The pain is frequently described as a constant dull ache, typically beginning in the muscles. On top of the pain that is felt there are areas of the body called tender poitns. When pressure is applied to any of these tender points, fibromyalgia patients will experience even more pain. There are about 9 different tender points on the body and include the back of the head, the upper chest, between the shoulder blades, and the inside of the knees.

-Fatigue. People suffering from fibromyalgia often wake up tired. Even after reporting sleeping for hours at a time.

-Sleep Disturbances. sleep is often disrupted by the pain from fibromyalgia. To make matters worse these patients also have other sleep disorders that include restless legs syndrome and sleep apnea.

-Cognitive Dysfunction. Also referred to as “fibrofog”. This can include problems with short and long term memories, impaired speech, inability to multi task, and short attention spans.

-Joint stiffness, may include TMJ.

-More difficult to numb with dental anesthesia.

Some of the other symptoms can include difficulty upon swallowing, irritable bowel syndrome, as well as numbness and tingling. Fibromyalgia is typically found alongside depression and anxiety, which may be due to difficulty in coping with the condition. The symptoms tend to build upon themselves making patients even more sensitive at each attack.

Causes Of Fibromyalgia

At this time, it is unknown for sure what causes fibromyalgia. It is believed that many factors work together to cause the disorder to occur. These factors include:

Genetics – It has been learned through research that fibromyalgia tends to run in families. So it is believed that certain genetic mutations may play a role in developing fibromyalgia. These same genetic mutations have also been linked with other syndromes of unknown origin as well as depression. It is believed the pain that is caused by fibromyalgia is the result of abnormal pain processing by the brain. Researchers have shown that there are functional and structural differences between fibromyalgia patients and healthy individuals. It is unknown however if these abnormalities are the cause.

There have also been studies done in Sweden regarding twins and they found that:

Identical twins with fibromyalgia have a 15% chance that their twin has fibromyalgia.

Fraternal twins with fibromyalgia have a 7% chance that their twin has fibromyalgia.

Infections/Illness – Some ilnesses appear to trigger or aggravate fibromyalgia.

Lifestyle. Poor lifestyle choices including being a smoker, obesity and lack of exercise may increase the risk of an individual developing fibromyalgia.

Trauma. This can be physical or even emotional. Post traumatic stress disorder (PTSD) has been linked in recent years to fibromyalgia.

How Is Fibromyalgia Diagnosed?

Unfortunately, there is not a single test to confirm fibromyalgia. Patients are generally diagnosed when all other known diseases or syndromes are ruled out. It is called differential diagnosis when used in medicine. Fibromyalgia is believed to be  under-diagnosed with only about 25 percent of the actual cases being diagnosed properly.

The most widely accepted set of classification criteria for research purposes was elaborated in 1990 by the Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as “the ACR 1990”, define fibromyalgia according to the presence of the following criteria:

-A history of widespread pain lasting more than three months—affecting all four quadrants of the body, i.e., both sides, and above and below the waist.

-Tender points—there are 18 designated possible tender points (although a person with the disorder may feel pain in other areas as well). Diagnosis is no longer based on the number of tender points.

How Is Fibromyalgia Managed?

Treatment is varied by individual. Each individual will present with different symptoms. So what type of therapy is available?

Psychological therapies

There have been benefits to behavioral therapies (cognitive behavioral therapy (CBT) ) coupled with exercise to have a small to moderate effect in reducing the symptoms of fibromyalgia.


-Analgesics. Acetaminophen (Tylenol) may ease the pain and stiffness associated with fibromyalgia. However, the effectiveness of acetaminophen has varied from patient to patient. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) — in conjunction with other medications.

-Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.

-Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Lifestyle Changes

Lifestyle changes are critical to managing the onset and symptoms of fibromyalgia. Some of the changes that can help include:

-Reduce stress in your life. Allow yourself time each day to relax. People who quit work or drop all activity tend to do worse than those who remain active. Stress Management techniques like meditation or deep breathing can really help in this area.

-Get Adequate sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is mandatory. In addition to getting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

-Regular Exercise. Initially, exercise may actually increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.

Check medications. Some meds have fibromyalgia side effects. Anticholesterol medications are a major culprit of  fibromyalgia symptoms. Try changing your diet to a healthier one incorporating mild exercise, and try to decrease your cholesterol level naturally.

-Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not “overdoing it” on your good days, but likewise it means not self-limiting or doing “too little” on the days when symptoms flare.

-Choose to make healthy nutritional choices. Choose a well balanced diet and limit your caffeine intake to the absolute minimum.

Alternative Medicine Choices

-Acupuncture. While many do not believe in acupuncture, it has been helpful for many ailments over the years.  It is believed the acupuncture needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Studies have shown improvements in fibromyalgia symptoms following acupuncture treatment.

-Massage therapy. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety.

-Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

Fibromyalgia Conclusion

Fibromyalgia is a disease that affects not only the sufferer but also those around him or her. It is an often misunderstood disease that can create frustration. Understanding and managing the symptoms is the goal. Proper choices and therapy can  allow fibromyalgia patients to live normal productive lives.