The orofacial system in early rheumatoid arthritis and individuals at risk: A window of opportunity for interprofessional collaboration

Rheumatoid arthritis (RA) is an auto-immune disease affecting the synovial joints. The current literature reports several interactions between RA and the orofacial system, such as an increased prevalence of temporomandibular disorders (TMD), reduced saliva production, and increased prevalence of dental plaque and caries. For periodontitis, a chronic inflammatory disease of the tooth-supporting tissues, bidirectional associations are found. Furthermore, it has been suggested that the oral microbiome may play a role in RA onset.
Due to the advantages of early intervention, there is an important focus on the timeframe around RA onset in research and clinical practice. However, current knowledge on possible orofacial complications in the preclinical and early stages of RA disease is very limited. Therefore, the main aim of this thesis is to contribute to this knowledge. A protocol for an observational study in early RA patients and individuals at risk of developing RA (chapter 2) and the resulting data on TMD (chapter 3), oral health and oral microbiome (chapter 6), and oral health-related quality of life (chapter 7) are presented. Further, the consequences (chapter 4) and a possible treatment (chapter 5) for TMJ involvement in RA are investigated.
In conclusion, the timeframe around RA onset may be considered a window of opportunity for the prevention of future orofacial complications. Screening for TMD and xerostomia in rheumatology care settings is strongly advised, and referral of newly diagnosed RA patients to a dentist – or at least encouragement of regular dental check-ups – seems justified. Accordingly, interprofessional collaboration is essential and thus advised.