Biotherapy and oral complications in Rheumatoid Arthritis

Biotherapy drugs can inhibit key factors that cause inflammation in Rheumatoid Arthritis (RA) and other autoimmune conditions. 
These drugs include Rituximab, one of the first biotherapies to be approved for RA, Infliximab, Etanercept and Abatacept.

Studies have shown that people being treated with biotherapies can have oral complications. These side effects obviously vary greatly depending on the dosage amount, the type of product and the way they are administered. If dentists are aware of these biotherapy agents and the possible side effects then they can be very helpful in arresting and preventing further damage and educating the patient.

The treatment of rheumatoid arthritis focuses on the suppression of immune system with the help of biotherapy agents. The oral complications caused by these agents include oral thrush, metallic taste, soreness and burning sensation of tongue, difficulty swallowing, cold sores on lips, xerostomia, ulcers, gingival bleeding, oral pain, white spots or patches, itching of lips and tongue, halitosis, burning of lips, pain in the jaw, and swelling in glands. Sharoot Malik and Sumaiya Kasbati, Dentistry iQ

Dentistry iQ
American Nurse Today 
NCBI US National Library of Medicine


Passive smoking and Rheumatoid Arthritis linked

rheumatoid arthritis and passive smoking study

Passive smoking in childhood has a rheumatoid arthritis link. 

This study was done with over 70,000 women at University Hospitals of South Paris. It discovered the alarming fact that the women who had been exposed to cigarettes smoke in their childhood had a significantly increased risk of getting Rheumatoid Arthritis in later life.
"Our study highlights the importance of avoiding any tobacco environment in children, especially in those with a family history of RA," said Professor Raphaele Seror.
The participants were asked if as a child they were in a smoky room and for how many hours a day. 

RA is the most common chronic inflammatory joint disease, affecting about 0.5-1% of the general population and causing progressive joint destruction, disability and reduced life expectancy. 

In recent years, many potential environmental factors have been associated with an increased risk of developing RA, but so far smoking is the only one that has been extensively studied. 

SOURCE: eular Press Releases for 16.06.17 pdf


The Rheumatoid Factor Test

The rheumatoid factor blood test (RF) helps diagnose Rheumatoid Arthritis (RA). It measures rheumatoid factor, a chemical in the blood of many, but not all, people with RA. By itself, it does NOT show whether you have rheumatoid arthritis or not.
The Rheumatoid Factor Test gives your doctor more information to consider when diagnosing your condition, it does not necessarily mean you have RA. It is used along with your physical exam, other tests, and your symptoms to help diagnose your condition.  

People with other autoimmune conditions, such as lupus and Sjogren's syndrome, can also have a positive Rheumatoid Factor. So can people with infections such as hepatitis and mononucleosis. 

False positives occur in 5% of healthy individuals and in up to 20% of people over 65 years of age. False positives also occur in inflammatory condition such as Sjögren's Syndrome, Lupus and Systemic Sclerosis.

Some healthy people can have rheumatoid factor in their blood too. Also some people with RA don’t have a positive RA result. That’s why this test will not,

The higher the level in rheumatoid disease the worse the joint destruction and the greater the chance of systemic involvement.

What Abnormal Results Mean

An abnormal result means the test is positive, which means higher levels of rheumatoid factor have been detected in your blood. The higher the level, the more likely one of these conditions is present. There are also other tests for these disorders that help make the diagnosis.
People with the following diseases may also have high levels of rheumatoid factor:
Other blood tests for rheumatoid arthritis:
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • anti-CCP (anit-cyclic citrullinated peptide) 

  1. Wilson D; Rheumatoid factors in patients with rheumatoid arthritis. Can Family Physician. 
  2. Longmore M, Wilkinson IB & Rajagopalan SR; Oxford Handbook of Clinical Medicine, 2004
  3. MedlinePlus 
  4. WebMD


What is polyarthritis?


  • It is any type of arthritis which involves 5 or more joints simultaneously
  •  It is usually associated with autoimmune conditions such as rheumatoid arthritis, amyloidosis, psoriatic arthritis, and lupus erythematosus.
  • It may be experienced at any age
  • It is found in both men and women
  • It can also be caused by infection with an alphavirus such as chikungunya virus and Ross River virus. This condition is termed alphavirus polyarthritis syndrome.
Polyarthritis for medical professionals:

MEDICAL ARTICLE: Inflammatory Polyarthritis in the Older Adult

Preventing rheumatoid arthritis

Some people have recently asked if rheumatoid arthritis can be prevented. Until the cause is understood it may be difficult to stop it.  Some factors do increase your risk of getting it and they include your gender, genetics and age but none of these factors can be controlled. Environmental factors are also thought to be a factor in the development of RA and I suppose they can be controlled to some degree.
Genetics certainly is a complex area and the genetics of rheumatoid arthritis are complex. "The genetic component of RA is widely investigated: the strongest gene association is considered to be the one with the human leukocyte antigen (HLA) region, particularly the HLA-DRB1 genes accounting for about two-thirds of the genetics of RA." Arthritis research & therapy

There is one thing that has been shown to increase the risk of rheumatoid arthritis, that can be controlled, and that is smoking.  Recently, it has been reported that smoking is involved in the development of many autoimmune diseases such as RA,  Lupus, Systemic sclerosis, Multiple sclerosis and Crohn's disease.

RESOURCES: Rheumatoid arthritis and smoking: putting the pieces together
Zsuzsanna Baka, Edit Buzás and György Nagy


Refined Sugars and Rheumatoid Arthritis

Excessive consumption of refined sugars, including white sugar, brown sugar and corn syrup, may increase the acidity of the body. Some natural health practitioners have recommended that refined sugar be avoided in cases of inflammatory disease such as rheumatoid arthritis. Substitution with natural sugar alternatives such as stevia, agave nectar, fruit juice concentrates and honey may help to reduce inflammatory processes. An overall reduction of any type of sugar can also be recommended to avoid rapid increases in blood sugar, which may interfere with inflammatory processes.

Many people feel that their pain is reduced if they cut out sugar altogether. Have you experimented with this? I found it difficult to do at first but well worth the reduction in pain especially in my fingers, wrists and ankles. I recommend the following program which gives you online support...

                                                  The 21-Day Sugar Detox


Risk of getting Rheumatoid Arthritis involves gene regulators

The kind of DNA once known as “junk” may influence people’s risk of getting rheumatoid arthritis, according to a study that offers the latest look at the complex system of switches that turn disease genes on.

Using genetic information from more than 300 people with rheumatoid arthritis and another 300 without, the researchers found 10 areas that appeared to influence risk, according to the research published yesterday in the journal Nature Biotechnology. 

Read full story at Bloomberg


Pacing and chronic pain

Pacing is learning to find the right balance between spending time on an activity without pushing yourself so that it significantly worsens your pain. Pacing is the opposite to just pushing through and finishing an activity and then being in so much pain the next day that you cannot cope with anything at all. It is about breaking activities up into small increments. It is about definately stopping when you start to feel pain or increased pain, depending on your situation. Pacing can help prevent flare ups and keep you mobile. Some people who are trying to pace themselves find it useful to set a time limit and also a rest time or a change of activity.

Here is a site that has helpful worksheets that can help you with pacing: PSYCHOLOGY TODAY

Pacing: Balancing activity and rest PDF Download from
Pacing instructions with worked examples PDF Download from Cambridge Univeristy Hospital
Pain management diary PDF Download from
The Pain Toolkit -  for people who live with persistent pain PDF Download from