Both periodontal disease and RA are unique diseases that have been suggested to require exposure to exogenous pathogens to initiate host inflammation, but the host factors propagate the destruction of hard and soft tissues at the site of local inflammation. In periodontal disease, this occurs at the junction of the gingival interface with the tooth, and in RA this occurs in the articular tissues. Many of the same proinflammatory mediators are present during tissue destruction in both diseases including IL-1, IL-6, CRP, TNF-α, INF-γ, and RANK ligand (RANKL). PISA and DAS values both characterize inflammation; PISA measures the inflamed surface area within a periodontal pocket, and DAS measures the articular and systemic disease activity of RA. Practitioners should consider utilizing more advanced clinical assessments of both RA and chronic periodontitis to allow for a more accurate evaluation of the disease conditions and to best select appropriate end points to therapy that relate to the overall inflammatory burden of each disease. Periodontal management of patients with RA should involve consultation with their rheumatologist and/or treating physician to ensure optimal patient care and safety.
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