{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:47:30Z","timestamp":1791859650737,"version":"4.3.4"},"reference-count":100,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Periodontitis (PD) is characterized by the host's inflammatory responses to microbial dental biofilm dysbiosis, potentially resulting in tooth loss if left untreated. Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease leading to synovial inflammation and destruction of joint cartilage and bone. The suggested association between PD and RA is based on the potential of chronic inflammation present in periodontitis, which could induce alterations in proteins through post\u2010translational modifications, leading to the formation of citrullinated and carbamylated protein antigens. Antibodies directed against these antigens can serve as biomarkers for the underlying immunological processes in RA. Recent studies have also focused on bacterial proteolytic enzymes released from PD\u2010associated bacteria, such as\n                    <jats:italic>Porphyromonas gingivalis<\/jats:italic>\n                    and\n                    <jats:italic>Aggregatibacter actinomycetemcomitans,<\/jats:italic>\n                    which are also sources of these antibodies. Chronic inflammation in PD causes increased levels of inflammatory cytokines (interferon\u2010\u03b1, interleukins\u20106 and 8, tumor necrosis factor\u2010\u03b1) and neutrophil extracellular traps (NETs). The oral microbiota in PD is also associated with the release of NETs (a process known as NETosis). Elevated NET levels are a source of citrullinated and carbamylated proteins which highlights their role in an individual's risk of developing RA (pre\u2010RA individuals) and the progression of chronic RA. This narrative review describes periodontitis and the dysbiotic subgingival microbiota and its role in NETosis as risk factors for inducing early RA and the prospects of identifying pre\u2010RA individuals and seronegative RA patients with these risk factors.\n                  <\/jats:p>","DOI":"10.1111\/1756-185x.15415","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T05:32:14Z","timestamp":1731303134000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Connecting the dots:\n                    <scp>NETosis<\/scp>\n                    and the periodontitis\u2010rheumatoid arthritis nexus"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7620-8244","authenticated-orcid":false,"given":"Maliha","family":"Shahbaz","sequence":"first","affiliation":[{"name":"Department of Restorative Dentistry, Faculty of Dentistry Universiti Malaya  Kuala Lumpur 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