The role of bacterial infections in rheumatoid arthritis development and novel therapeutic interventions: Focus on oral infections

Abstract

Background

Rheumatoid arthritis (RA) represents a primary public health challenge, which is a major source of pain, disability, and socioeconomic effects worldwide. Several factors contribute to its pathogenesis. Infections are an important concern in RA patients, which play a key role in mortality risk. Despite major advances in the clinical treatment of RA, long-term use of disease-modifying anti-rheumatic drugs can cause serious adverse effects. Therefore, effective strategies for developing novel prevention and RA-modifying therapeutic interventions are sorely needed.

Objective

This review investigates the available evidence on the interplay between various bacterial infections, particularly oral infections and RA, and focuses on some potential interventions such as probiotics, photodynamic therapy, nanotechnology, and siRNA that can have therapeutic effects

CONCLUSIONS

The presented evidence indicates that different bacterial pathogens alone or in inter-bacterial interactions directly associate with the pathogenesis of RA. The link between microbial dysbiosis and RA should open up interesting therapeutic prospects at a time when we are in urgent need of new alternative treatments. Eventually, clinical trials involving complementary therapies are necessary to provide a definite answer as to the applicability of each approach. In addition, basic and comprehensive researches at the molecular level are needed to fully understand the mechanism of the mentioned therapeutic interventions. Meanwhile, combination therapy should be investigated in detail to increase the retention time and efficiency of therapeutics. Moreover, formulation-related safety concerns and obstacles should be evaluated systematically.