Monday, 29 June 2009

Arthritis and gum disease?

If you went to see your general practitioner and started talking simultaneously about having painful bleeding gums and arthritic knees, what do you think their response would be?
Are they the laid-back type who might ask you about your general health and suggest a multi-vitamin supplement with glucosamine? Or maybe they politely stifle a laugh and try to reassure you that this is a pure coincidence.
If you persisted in telling them you believed the two things were linked - maybe you had some jaw pain with the inflamed gums as the same time as the knee pain - how would they respond? Their body posture might become more defensive and they may lean seriously over the desk in a way which reassures you who the medical expert is.
If they agreed to treat both symptoms, it is likely you would walk out of the consulting room with two separate prescriptions; one for the mouth, the other for the knee pain.
Unfortunately most of our doctors are not scientists. And of course none of them have time to spend examining medical research journals - there are far to many of them. So they won't have read the Journal of Periodontology 2009, Volume 80, No.4.
There is a direct link between treating gum disease and improving Rheumatoid Arthritis, a joint study by periodontology, rheumatology and epidemiology specialists have concluded. They have given clear evidence to back up similar recent studies revealing this possibility.
Surprisingly, arthritis patients who received dental hygiene treatments, such as scale removal, and also advice on maintaining their oral health, subsequently found their arthritic symptoms reduced significantly.
The positive results were the same even between those on standard medical treatment for RA and those receiving the cutting-edge anti-tumor necrosis factor-alpha treatment. Who would have thought going to the hygienist regularly would keep arthritis at bay?
From looking at the abstract of this research it is not clear why such a link might be made. But all those gleaming TV ads for dental products show one thing - there is money to be had for research in to those nasty bacteria which cause dental disease.
Conversely there is not much money around for investigating a bacterial cause for arthritis.
Would a drug company spend money on investigating something with possibly wide-ranging epidemiological causes? I don't think they would rush to innovate and develop new drug patents for what could be a non-specific target market.
This area of research faces 'multiple challenges' according to a study in Current Opinion in Rheumatology (Epidemiologic approaches to infection and immunity: the case of reactive arthritis: Rohekar, Sherry; Pope, Janet). The Canadian researchers were aware of the 'significant evidence that infection and arthritis are linked' and reviewed all the current studies relating to the specific condition Reactive Arthritis (ReA).
Connections to ReA have been established from outbreaks of gastroenteritis and from other, less obvious, bacterial infections. The nastier the infection, the greater the risk of getting ReA apparently.
More careful epidemiological studies are going to be necessary, the researchers concluded, particularly as higher rates of self-reported cases of arthritis have been discovered in the population than first thought.
So, if you have a set of symptoms that seem completely unrelated, push for your doctor to take a holistic view - and book a visit to the hygienist just in case!

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